Superior sulcus (Pancoast) tumor: experience with 105 patients.
BACKGROUND
The evolution of therapy in 105 patients with superior sulcus (Pancoast) tumor over the past 42 years was reviewed.


METHODS
There 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. There were 5 treatment groups: I, preoperative radiation and operation (n = 28); II, operation and postoperative radiation (n = 16); III, radiation (n = 37); IV, preoperative chemotherapy, radiation, and operation (n = 11); and V, operation (n = 12).


RESULTS
The median survival for 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 been reached (estimated at 72% at 5 years). On univariate analysis, mediastinal lymph node involvement, Horner syndrome, TNM classification, and method of therapy affected survival. On multivariate regression analysis, only N2 and N3 disease and method of therapy were significant (p < 0.05).


CONCLUSIONS
The optimal treatment for superior sulcus tumor was preoperative radiation and operation. However, triple modality therapy, although promising, requires longer follow-up.
Department of Surgery, University of Maryland Hospital, Baltimore 21201, USA. sattar@surgery1.umaryland.edu
S
S
Attar
M J
MJ
Krasna
J R
JR
Sonett
J R
JR
Hankins
R G
RG
Slawson
C M
CM
Suter
J S
JS
McLaughlin
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000708:Anaplasia; D018287:Carcinoma, Large Cell / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006732:Horner Syndrome / Q000209:etiology; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010178:Pancoast Syndrome / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011013:Pneumonectomy; D018714:Radiotherapy, Adjuvant; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate