Outcome predictors for 143 patients with superior sulcus tumors treated bymultidisciplinary approach at the University of Texas M. D. Anderson Cancer Center

Purpose: Superior sulcus tumors (SST) of the lung are uncommon and constitu te approximately 3% of non-small cell lung cancer (NSCLC), These tumors cau se specific symptoms and signs, and are associated with patterns of failure that differ from those seen for NSCLC tumors in other nonapical locations. Prognostic factors and most effective treatments are controversial. We con ducted a retrospective study at The University of Texas M. D. Anderson Canc er Center to identify outcome predictors for patients with SST treated by a multidisciplinary approach. Methods and Materials: This retrospective review of 143 patients without di stant metastasis at presentation is a continuation of a previous M. D. Ande rson study now updated to 1994. In this study, we examine the 5-year surviv al rate by pretreatment tumor and patient characteristics and by the treatm ents received. Strict criteria were used to define SST, Actuarial life-tabl e analyses and Cox proportional hazard models were used to compare survival rates. Results: Overall predictors of 5-year survival were weight loss (p < 0.01), supraclavicular fossa (p = 0.03), or vertebral body (p = 0.05) involvement , stage of the disease (p < 0.01), and surgical treatment (p < 0.01), Five- year survival for patients with Stage IIB disease was 47% compared to 14% f or Stage IIIA, and 16% for Stage IIIB. For patients with Stage IIB disease, surgical treatment (p < 0.01) and weight loss (p = 0.01) were significant independent predictors of 5-year survival. Among patients with Stage IIIA d isease, the only predictor of survival was Karnofsky performance score (KPS ) (p = 0.02), For patients with Stage IIIB disease, the only independent pr edictor of survival was a right superior sulcus location, which was associa ted with a worse 5-year survival rate than that for patients with tumors in the left superior sulcus (p = 0.02). More patients with adenocarcinoma tha n with squamous cell tumors experienced cerebral metastases within 5 years (p < 0.01). Patients without gross residual disease after surgical resectio n who received postoperative radiation therapy with total doses of 55 to 64 Gy had a 5-year survival rate of 82% as compared with the 5-year survival rate of 56% in patients who received 50 to 54 Gy. Twenty-three patients sur vived for longer than 3 years. Of these, 4 patients (17%) received radiatio n therapy alone or in combination with chemotherapy without surgical resect ion, The other 19 patients (83%) had resection combined with radiation ther apy and/or chemotherapy, Conclusions: The findings from this study confirm the importance of the new staging system, separating T3 N0 M0 (Stage IIB) from Stage IIIA, since the re was a significant difference in the 5-year survival (p < 0.01), interest ingly, there was no significant 5-year survival difference between Stage II IA (N2) and Stage IIIB (T4 or N3), This study also suggests that surgery is an important component of the multidisciplinary approach to patients with SST if their nodes were negative. Disease that is minimally invading surrou nding normal structures can be resected followed by radiation therapy in do ses of 55 to 64 Gy, Further investigation of treatment strategies combining high-dose radiation therapy (greater than or equal to 66 Gy) with chemothe rapy is indicated for patients with unresectable and/or node-positive (N2) SST. (C) 2000 Elsevier Science Inc.