COMBINED TREATMENT IN SUPERIOR SULCUS TUMORS

From January 1988 to August 1992, 18 patients (pts) with the establish ed diagnosis of non-small cell lung cancer of the superior sulcus have been treated with a multidisciplinary approach, which includes 1-3 cy cles, of neoadjuvant chemotherapy (MVP or MCP regimens) followed by si multaneous preoperative chemotherapy and external beam irradiation. Ra dical surgery plus intraoperative radiotherapy (IORT) was planned 4-5 weeks after the end of the preoperative protocol. Tumor stages were II IA (9 pts) and IIIB (9 pts). Tumor characteristics included rib and ve rtebral involvement in 15 and 4 pts, respectively. Fatal toxicity was present in 3 pts (16.6%). Resectability rate was 76.4%. Pathologic fin dings disclosed complete response (pT0) in 70.5% of the surgical speci mens and viable tumor (pT+) in 29.5%. With a median follow-up of 24+ m onths (2-52+), 4-year actuarial local control, and overall survival ra tes are 91% and 56.2%, respectively. Four-year actuarial overall survi val according to pathologic response was 87.5% for pT0 patients and 20 % for pT + patients. We conclude that this regimen promotes a high rat e of pT0 as well as better than expected local control and survival ra tes. The presence of a pT0 specimen seems to correlate with the patien t outcome.