SUPERIOR SULCUS (PANCOAST) TUMOR - EXPERIENCE WITH 105 PATIENTS

Background. The evolution of therapy in 105 patients with superior sul cus (Pancoast) tumor over the past 42 years was reviewed. Methods. The re were 82 men and 23 women aged 30 to 75 years. Tumor cell types were : squamous, 41 (39%); adenocarcinoma, 23 (21.9%); anaplastic, 14 (13.3 %); undetermined, 12 (11.4%); mixed, 9 (8.7%); and large cell 6 (5.7%) . Therapy was based on extent of disease and lymph node involvement. T here were 5 treatment groups: I, preoperative radiation and operation (n = 28); II, operation and postoperative radiation (n = 16); III, rad iation (n = 37); IV, preoperative chemotherapy, radiation, and operati on (n = 11); and V, operation (n = 12). Results. The median survival f or group I was 21.6 months; group II, 6.9 months; group III, 6 months; and group V, 36.7 months. Median survival for group IV has not yet be en reached (estimated at 72% at 5 years). On univariate analysis, medi astinal lymph node involvement, Horner syndrome, TNM classification, a nd method of therapy affected survival. On multivariate regression ana lysis, only N2 and N3 disease and method of therapy were significant ( p < 0.05). Conclusions. The optimal treatment for superior sulcus tumo r was preoperative radiation and operation. However, triple modality t herapy, although promising, requires longer follow-up. (Ann Thorac Sur g 1998;66:193-8) (C) 1998 by The Society of Thoracic Surgeons.