The use of concurrent chemotherapy with high-dose radiation before surgical resection in patients presenting with apical sulcus tumors

PURPOSE Patients presenting with apical sulcus tumors have historically been treate d with preoperative radiotherapy followed by surgical resection. Since 1991 , we have delivered an induction regimen consisting of combination chemothe rapy and high-dose radiation in an attempt to improve tumor responses and i ncrease survival for this patient population. PATIENTS AND MATERIALS This retrospective analysis consisted of 23 (13 men and 10 women) consecuti ve patients who completed trimodality therapy. The median age was 53 years. Histologies included adenocarcinoma (nine patients), squamous cell (five p atients), large cell (three patients), and undifferentiated non-small cell lung carcinoma (six patients). Pretreatment stages were T3N0 (14 patients), T3N2 (two patients), T3N3 tone patient), T4N0 (five patients), and T4N2 to ne patient). Preoperative therapy consisted of daily radiotherapy (median d ose, 59.4 Gy) delivered at 1.8 Gy/day and concurrent combination chemothera py consisting of either two cycles of cisplatin and etoposide or weekly car boplatin and paclitaxel. Surgical resection typically included lobectomy wi th chest wall resection. RESULTS All 23 patients were available for analysis of response and survival. The m edian follow-up was 53 months. The median number of days between completion of induction therapy and surgery was 56 days. Postoperative complications included prolonged atelectasis (two patients), pulmonary embolism tone pati ent), subarachnoid-pleural fistula tone patient), and deep vein thrombosis in the subclavian Vein tone patient). The pathological complete response ra te to induction therapy was 46% for the entire group. An additional 38% had evidence of tumor regression at the time of surgery. The 5-year disease-fr ee and overall survivals were 36% and 49%, respectively. The median overall survival was 33 months. The median overall survival for those who achieved a pathological complete response has not been reached. Analysis of factors including age, sex, histology, differentiation, stage of disease, and radi ation dose failed to identify any predictors of response or survival. CONCLUSION Concurrent chemotherapy and high-dose radiation can be safely delivered bef ore surgery in patients presenting with apical sulcus tumors. Our results c ompare favorably to other institutional series and support the further inve stigation of this approach in prospective trials.