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Ann Thorac Surg 2005;79:1174-1179
© 2005 The Society of Thoracic Surgeons

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Original articles: General thoracic

The Surgical Management of Superior Sulcus Tumors: A Retrospective Review With Long-Term Follow-Up

^a Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
^b Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
^c Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
^d Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania

Accepted for publication September 7, 2004.

^_* Address reprint requests to Dr Goldberg, Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111-2497 (E-mail: m_goldberg{at}fccc.edu).

BACKGROUND: We reviewed our experience with multimodality therapy for superior sulcus tumors to identify aspects of treatment that impact survival.

METHODS: We retrospectively analyzed the records of 39 consecutive patients who underwent surgical resection in a single institution between 1993 and 2000.

RESULTS: Median age at presentation was 59 years (range, 40 to 77). Twenty-five patients (64%) were men. At presentation, 36 patients (92%) had clinical T3 tumors and 3 (8%) had clinical T4 tumors. Mediastinoscopy was negative in all patients. Thirty-one patients (79%) received preoperative radiotherapy (median dose, 4500 cGy). Chemotherapy was administered concurrently with radiotherapy in 27 patients (69%). Complete surgical resection was performed in 34 patients (87%). There were 2 (5%) postoperative deaths. Of the 31 patients who received preoperative therapy, 14 (45%) had their tumors downstaged and 9 (29%) demonstrated a complete pathologic response. Median follow-up (100%) was 69 months. Overall 5-year survival was 47.9%. Five-year survival was 52.1% in patients with negative resection margins (p = 0.005), and 60.6% in patients who demonstrated a response to induction chemoradiation therapy (p = 0.008). Independently, margin status and response to induction therapy are predictors of overall survival (p = 0.01 and p = 0.02, respectively). Multivariable analysis identified margin status as the only factor significantly associated with overall survival. Negative margins strongly correlated with the response to preoperative therapy (p = 0.004). Disease-free survival correlated well with the response to induction therapy (p = 0.03). The chemotherapy regimen, T status, operative procedure, and complete pathologic response did not correlate with survival.

CONCLUSIONS: The use of chemoradiation induction therapy may downstage tumors, enhance the ability to obtain a complete surgical resection, and prolong survival.