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The Annals of Thoracic Surgery, Vol 57, 1440-1445, Copyright © 1994 by The Society of Thoracic Surgeons
RJ Ginsberg, N Martini, M Zaman, JG Armstrong, MS Bains, ME Burt, PM McCormack, VW Rusch and LB Harrison
We analyzed the results of surgical treatment of all patients presenting
with untreated superior sulcus tumors between 1974 to 1991 inclusive at our
institution. Most patients received preoperative radiotherapy. We attempted
to analyze the influence of surgical resection and intraoperative
brachytherapy in obtaining locoregional control and disease-free survival.
One hundred twenty-four patients underwent thoracotomy and 100 patients
underwent resection. The overall 5-year survival rate was 26% for all
patients and 30% for resected patients. Those patients receiving a complete
resection achieved a 41% 5-year survival. The best single group were those
patients undergoing a lobectomy (versus wedge resection) and en-bloc chest
wall resection (60% 5-year survival). We were unable to demonstrate an
advantage for the use of intraoperative brachytherapy in those patients
with complete resection. For those patients with incomplete resection, the
use of brachytherapy combined with preoperative or postoperative external
radiation therapy resulted in a 9% 5-year survival. Locoregional failure
was significant both in patients with complete resection and in patients
with incomplete resection. Adverse prognostic factors included Horner's
syndrome, N2 and N3 disease, T4 disease, and incomplete resections. In
superior sulcus tumors, every attempt to completely resect the tumor by
en-bloc chest wall resection combined with lobectomy and adequate nodal
staging remains the surgical treatment of choice together with either
preoperative, postoperative, or "sandwich" external radiation therapy.
ARTICLES
Influence of surgical resection and brachytherapy in the management of superior sulcus tumor
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
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