Surgical Treatment of Superior Sulcus Tumors: Results and Prognostic Factors

Background: This study aims to investigate the treatment modalities and factors influencing survival in surgically treated superior sulcus tumors. Patients and Method: Sixty-five cases of surgically treated non-small cell carcinoma of the lung occurring as superior sulcus tumors between 1994 and 2007 were retrospectively reviewed. Twenty-five patients underwent induction radiotherapy (RT), 10 had induction chemoradiotherapy (CT/RT). In thirty patients surgery was performed directly. The mortality rate was 6.2%. Pathological stage was T3 in 55, T4 in 10, NO in 52, and N1 in 5 and N2 in 8 patients. Results: Overall 5- and 10-year survival rates were 31 % and 28%, respectively. Complete resection rate was 90% for patients who received induction CT/RT and 80% for patients who either received induction RT alone or patients in whom surgery was performed directly. In patients who received neoadjuvant therapy with complete tumor resection, the median survival time was 33 months (28 months for patients who received induction RT alone and 36 months for patients who received induction CT/RT), and the 5-year survival rate was 41 %. Median survival time and 5-year survival rate of patients treated by direct surgery with complete resection was 24 months and 37%, respectively (p = 0.87). Five-year survival and 10-year survival rates were significantly higher after complete resection than after incomplete resection (38% and 34% vs. 0%, p=0.0001). In multivariate analysis, only N2 disease (p = 0.04) and incomplete resection (p = 0.03) were found to be poor prognostic factors. Conclusion: The presence of N2 disease and incomplete resection are the two most important factors affecting survival. Induction CT/RT may increase the ability to achieve complete surgical resection.