For superior sulcus tumors, combined modest-dose preoperative radiation therapy (30 to 45 Gy) followed by radical surgical resection yields a 5-year survival of >30%* (Table 2). This survival may be improved by supplemental postoperative radiation therapy in selected patients at high risk for recurrence, namely, those with positive nodes or close or involved resection margins. The results of these combined-approach series for superior sulcus tumors are more favorable than those of radiation-only series (5-year survival, 22% to 23%), although the complication rate may be lower with the latter approach. For patients with marginally resectable disease (Table 3), modest doses of preoperative radiation therapy (30 to 40 Gy) convert a large proportion of patients to resectability and may improve the survival rate over that for radiation therapy alone (27% vs 8%). For patients with unresectable disease, 40 Gy of preoperative radiation therapy converts about one third to resectability, but the 5-year survival (6% to 8%) is not superior to that with radiation therapy alone. Preoperative radiation does not appear to offer any benefit to patients whose tumor is resectable at diagnosis.
Intraoperative Radiation Therapy: Intraoperative radiation therapy has been utilized in several studies’ as a primary mode of therapy for patients with stage 1 or 2 disease discovered to be unresectable at thoracotomy or as an adjunct for incompletely resected stage 3 tumors.
Table 2—Results in Retrospective Series of Superior Sulcus Tumors
|Treatment||Reference||No. of Patients||5-Year Survival, %|
|Pre- and postoperative||4||22||34|
|Radiation therapy alone||6||36||23|
Table 3—Effect of Preoperative Radiation Therapy on Marginally Resectable or Unresectable Tumors
|Type of Tumor||Reference||No. of Patients||5-Year Survival, %|