INFLUENCE OF SURGICAL RESECTION AND BRACHYTHERAPY IN THE MANAGEMENT OF SUPERIOR SULCUS TUMOR

We analyzed the results of surgical treatment of all patients presenti ng with untreated superior sulcus tumors between 1974 to 1991 inclusiv e at our institution. Most patients received preoperative radiotherapy . We attempted to analyze the influence of surgical resection and intr aoperative brachytherapy in obtaining locoregional control and disease -free survival. One hundred twenty-four patients underwent thoracotomy and 100 patients underwent resection. The overall 5-year survival rat e was 26% for all patients and 30% for resected patients. Those patien ts receiving a complete resection achieved a 41% 5-year survival. The best single group were those patients undergoing a lobectomy (versus w edge resection) and en-bloc chest wail resection (60% 5-year survival) . We were unable to demonstrate an advantage for the use of intraopera tive brachytherapy in those patients with complete resection. For thos e patients with incomplete resection, the use of brachytherapy combine d with preoperative or postoperative external radiation therapy result ed in a 9% 5-year survival. Locoregional failure was significant both in patients with complete resection and in patients with incomplete re section. Adverse prognostic factors included Horner's syndrome, N2 and N3 disease, T4 disease, and incomplete resections. In superior sulcus tumors, every attempt to completely resect the tumor by en-bloc chest wall resection combined with lobectomy and adequate nodal staging rem ains the surgical treatment of choice together with either preoperativ e, postoperative, or ''sandwich'' external radiation therapy.