Superior sulcus tumors: Results of irradiation of 36 patients

Abstract

Thirty-six patients with superior sulcus tumors were treated primarily with irradiation at the Medical College of Wisconsin Affiliated Hospitals between 1963–1977. Two patients were Stage II (T2NO) and 34 patients were Stage III (22: T3NO and 12: T1-3N2). Local control correlated positively with the field size for the thoracic irradiation, but not with total dose (between 40 Gy in four weeks and 64 Gy in 6 1/2 weeks). Thirty-one patients (86%) had relief of symptoms for a median of 12 months after irradiation. Seventeen patients (47%) achieved local control and showed a significantly longer median survival (26.5 months vs. 6.5 months) and a higher probability of five-year survival (45% vs. 0) compared with those who did not. Of 19 patients with local failure, distant metastases developed in nine. The most common first and single metastatic site was the brain. Brain metastases developed in seven patients, six of whom had control of the primary tumor. Three of them were alive at 65, 35, and 25 months after whole-brain irradiation. The five-year actuarial survival rate was 23%. There were no major complications. The prognosis was related to local control, but was unrelated to age, histology, symptoms, and signs at presentation, or mediastinal involvement, perhaps the result of the small number of patients studied. The prognosis for patients with superior sulcus tumors is more favorable than other presentations of carcinoma of the lung, but patients are especially at risk for single-organ brain metastases. Primary external radiotherapy is as effective as combined approaches and has a low complication rate; therefore, it is to be preferred for most patients with apical tumors.