Non-small-cell Superior Sulcus Tumor: Results of En Bloc Resection in Fifty-six Patients

Abstract

Background: Various multidisciplinary approaches are taken in the treatment of superior sulcus tumors. The purpose of this study was to determine the outcome, long-term results, and factors associated with prolonged survival after administering different combined radiosurgical regimens in a single institution. Methods: Between 1986 and 2000, 56 patients (43 men, 13 women) with superior sulcus tumor and histology of non-small-cell lung cancer underwent surgical resection. There were four treatment groups: I - preoperative radiation and operation (n = 15); II - preoperative radiation, operation and postoperative radiation (n = 22); III - operation and postoperative radiation (n = 10) and IV - no radiotherapy (n = 9). Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed for significance by log-rank test and Cox regression analysis. Results: The five-year survival rate after complete resection and N0/1 was 34 %. Of the prognostic factors analyzed, the histology, type of irradiation regimen and Horner's syndrome did not influence survival. Completeness of resection and mediastinal lymph node involvement clearly influences survival in univariate analysis. Age, sex and TNM classification were found to be independent significant prognostic factors for survival following resection. Conclusion: With superior sulcus tumors, every attempt should be made to resect the tumor completely by en bloc chest-wall resection with lobectomy and systematic hilar and mediastinal lymph node dissection. Mediastinal exploration by routine mediastinoscopy is recommended for identification of patients with advanced nodal involvement. Long-term survival may be relative to care taken in patient selection and extent of the resection performed. No significant difference in survival of patients with different irradiation regimens could be demonstrated in this study.

Key words

Pancoast - NSCLC - prognostic factors

References

• 1 Hare E S. Tumor involving certain nerves (Letter), London.  Med Gaz. 1838;  1 16-18
• 2 Pancoast H K. Superior pulmonary sulcus tumor: tumor characterized by pain, Horner's syndrome, destruction of bone and atrophy of hand muscles.  JAMA. 1932;  99 1391-1396
• 3 Paulson D L. Carcinoma of the lung. Curr Probl Surg 1967: 1-64
• 4 Chardack W M, MacCallum J D. Pancoast tumor: five-year survival without recurrence or metastases following radical resection and postoperative irradiation.  J Thorac Surg. 1956;  31 535-542
• 5 Shaw R R, Paulson D L, Kee J L. Treatment of the sulcus superior tumor by irradiation followed by resection.  Ann Surg. 1961;  154 29-36
• 6 Shahian D M, Neptune W B, Ellis F H. Pancoast tumors: improved survival with perioperative and postoperative radiotherapy.  Ann Thorac Surg. 1987;  43 32-38
• 7 Kaplan E L, Meier P. Non-parametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
• 8 Peto R, Peto J. Asymptomatically efficient rank invariant test procedures.  JR Stat Soc A. 1972;  135 185-206
• 9 Cox D R. Regression models and life-table (with discussion).  JR Statist Soc, Series B. 1972;  34 187-220
• 10 Attar S, Krasna M J, Sonett J R, Hankins J R, Slawson R G, Suter C M, McLaughlin J S. Superior sulcus (Pancoast) tumor: experience with 105 patients.  Ann Thorac Surg. 1998;  66 193-198
• 11 Dartevelle P, Macchiarini P. Surgical management of superior sulcus tumors.  The Oncologist. 1999;  4 398-407
• 12 Ginsberg R J, Martini N, Zaman B S, Armstrong J G, Bains M S, Burt M E, McCormack P M, Rusch V W, Harrison L B. Influence of surgical resection and brachytherapy in the management of superior sulcus tumor.  Ann Thorac Surg. 1994;  57 1440-1445
• 13 Maggi G, Casadio C, Pischedda F, Giobbe R, Cianci R, Ruffini E, Molinatti M, Mancuso M. Combined radiosurgical treatment of Pancoast tumor.  Ann Thorac Surg. 1994;  57 198-202
• 14 Komaki R, Roh J, Cox J D, Lopez Da Conceicao A. Superior sulcus tumors: results of irradiation of 36 patients.  Cancer. 1981;  48 1563-1568
• 15 Van Houtte P, MacLennon I, Poulter C, Rubin P. External radiation in the management of superior sulcus tumor.  Cancer. 1984;  54 223-227
• 16 Muscolino G, Valente M, Andreani S. Pancoast tumours: clinical assessment and long-term results of combined radiosurgical treatment.  Thorax. 1997;  52 284-286
• 17 Niwa H, Masaoka A, Yamakawa J Fukai I, Kiriyama M. Surgical therapy for apical invasive lung cancer: different approaches according to tumor location.  Lung cancer. 1993;  52 284-286
• 18 Komaki R, Putnam JB J B, Walsh G, Lee J S, Cox J D. The management of superior sulcus tumors.  Semin Surg Oncol. 2000;  18 152-164
• 19 Rusch V W, Giroux D J, Kraut M J, Crowley J, Hazuka M, Johnson D, Goldberg M, Detterbeck F, Shepherd F, Burkes R, Winton T, Deschamps C, Livingston R, Gandara D. 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).  J Thorac Cardiovasc Surg. 2001;  121 472-483
• 20 Yashar J, Weitberg A B, Glicksman A S, Posner M R, Feng W, Wanebo H J. Preoperative chemotherapy and radiation therapy for stage IIIa carcinoma of the lung.  Ann Thoarc Surg. 1992;  53 445-448