Carcinoma of the superior pulmonary sulcus treated with surgery and/or radiation therapy

Abstract

This is a retrospective analysis of 50 patients with carcinoma of the superior pulmonary sulcus, treated with curative intent at the University of Florida between October 1964 and October 1981. Treatment groups included preoperative radiation therapy and surgery (40 patients), radiation therapy alone (7 patients), and surgery with postoperative radiation therapy (3 patients). There was a minimum 2-year follow-up. Local control was obtained in 8 of 26 evaluable patients (31%) treated with preoperative radiation therapy and surgery, 2 of 6 patients treated with radiation therapy alone, and 0 of 2 patients treated with surgery and postoperative radiation therapy. Twelve (30%) of 40 patients receiving planned preoperative radiation therapy did not undergo definitive surgery. Absolute survival free of disease at 5 years by treatment group for patients at risk was 3 of 30 (10%) with preoperative radiation therapy and surgery, 0 of 3 with surgery and postoperative radiation therapy, and 2 of 7 with radiation therapy alone. Since one third of the patients who received low- to moderate-dose preoperative radiation therapy did not undergo definitive surgery, and since there is a small but significant survival with radiation therapy alone, it seems unwise to give moderate-dose preoperative radiation therapy, which implies an unfavorable radiation technique for the unresectable cases. The recommendation is to treat patients with lesions believed to be resectable by initial surgical resection followed by high-dose radiation therapy in selected patients with questionable margins or positive lymph nodes. Those patients with borderline or apparently unresectable lesions are recommended to be treated with radiation therapy alone.

Surgical Treatment of Superior Sulcus Tumors

“…According to previous reports, complete resection is the most important factor decisive of a good prognosis. [2][3][4][6][7][8][15][16][17][18][19] In the present series, complete resection was achieved in 11 (69%) of the 16 patients, in accordance with previous reports. 5,18,19 On the other hand, even though the surgical margin seemed to be negative macroscopically during surgery, in the other 5 (31%) patients, macroscopic examination revealed positive surgical margins.…”

“…There was no postoperative mortality in our small series, but mortality rates ranging from 5% to 14% have been reported by others. [2][3][4][5][6][7][8]15,17,18 The overall 5-year survival rates in large series range from 10% to 35%. 3,7,8,10,19 This variability seemed to depend on various patient conditions, the number of patients operated on, and the induction therapy.…”

Induction chemoradiation and surgical resection for non–small cell lung carcinomas of the superior sulcus: Initial results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160)

“…This experience has subsequently been confirmed by multiple small surgical series. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] A recent review of 225 patients operated on from 1974 to 1998 for superior sulcus tumors at Memorial Sloan-Kettering Cancer Center, the largest surgical series to date, indicated that actuarial survival at 5 years was 46% for stage IIB, 0% for stage IIIA, and 13% for stage IIIB tumors. Survival was influenced by T and N status and completeness of resection.…”

Superior Sulcus Tumors: A Mini-Review

“…Radiation therapy (RT) has been used as a single modality as well as in multimodality therapy. Monotherapy results are generally poor, however, and a 5-year survival rate of 23% has been reported [27,28]. Variations in dose, treatment technique, and staging and the lack of reporting of treatment-related morbidity have made the effectiveness of radiation therapy difficult to assess.…”