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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cemal Asim Kutlu Muzaffer Metin Adnan Sayar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kutlu, C. A. Articles by Sayar, A. Search for Related Content PubMed Articles by Kutlu, C. A. Articles by Sayar, A. Related Collections Related Article

Ann Thorac Surg 1998;66:2160
© 1998 The Society of Thoracic Surgeons

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Correspondence

Superior sulcus tumors

^a Yedikule Chest Surgery Center, Zeytinburnu 34760,, Istanbul, Turkey

e-mail: cakutlu{at}turk.net

To the Editor

We read with interest the article by Attar and associates entitled "Superior Sulcus (Pancoast) Tumor: Experience With 105 Patients" [1]. Treatment modalities for superior sulcus tumor (SST) have been debated without a consensus since Shaw et al reported the results of the patients who had preoperative radiotherapy and operation in 1961 [2]. Despite Attar and associates’ report of one of the largest series of SST in the literature, we found it very difficult to make a conclusion regarding the treatment of SST because of the heterogeneity of the patients in their series. Over 42 years, the management of lung cancer has changed significantly. The patients who underwent operations at the beginning of the study period cannot be classified in the same group with those who had operations in recent years. Survival analysis regarding mediastinal nodal invasion must be misleading because of the lack of evaluation of the mediastinum throughout the 35-year period when they did not perform systemic lymph node dissection. We also wonder how the authors detected N₃ disease at the beginning of the study period, when mediastinoscopy had not yet been defined.

The survival rates in groups 1 through 5 are not comparable without reporting the selection criteria for each group. We have no idea of the indications for preoperative radiotherapy in group 1, computed tomography plus radiotherapy in group 4, postoperative radiotherapy in group 2, and operation only in group 5. Unfortunately, the authors did not report their current practice on the preoperative evaluation and treatment modalities for these patients after 42 years’ experience. Our limited experience of SST suggests that magnetic resonance imaging increases the rate of complete resection significantly. Attar and associates reported a significant complete resection rate in 67 patients who had operations with a curative intent (92.4%). We find it hard to believe that the margins of all the resected specimens were examined satisfactorily unless the authors can provide the preoperative investigations they perform routinely and the selection criteria for the operation, to increase the complete resection rate to greater than 90%.

We think that a survival analysis of patients with SST must be made very carefully with a retrospective analysis. Controversy still remains regarding the treatment of SST in the literature because of the limited number of patients in most reported series and the heterogeneity of the patients in the larger series. A multicenter, randomized, prospective study is required to demonstrate the benefits of pre- and postoperative radiotherapy and chemotherapy in patients with SST who can be divided into groups with well-defined selection criteria.

References

1. Attar S., Krasna M.J., Sonnet J.R., et al. Superior sulcus (Pancoast) tumor: experience with 105 cases. Ann Thorac Surg 1998;66:193-198.[Abstract/Free Full Text]
2. Shaw R.R., Paulson D.L., Kee J.L. Treatment of the superior sulcus tumor by irradiation followed by resection. Ann Surg 1961;154:29-40.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cemal Asim Kutlu Muzaffer Metin Adnan Sayar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kutlu, C. A. Articles by Sayar, A. Search for Related Content PubMed Articles by Kutlu, C. A. Articles by Sayar, A. Related Collections Related Article