title: A prospective phase 2 study of surgery followed by chemotherapy and radiation for superior sulcus tumors.
abstract: BACKGROUND
  The optimal treatment for locally advanced superior sulcus tumors is not clear. The authors report long-term results of a trial examining the safety and efficacy of surgery followed by concurrent chemoradiation therapy for this disease.
  
  
  METHODS
  Thirty-two patients with resectable or marginally resectable superior sulcus tumors at The University of Texas MD Anderson Cancer Center from 1994 to 2010 were enrolled in a prospective trial. Surgery involved segmentectomy or lobectomy with en bloc resection of the involved chest wall and complete nodal staging; radiation therapy (RT) began 14 to 42 days later to a dose of 60 grays (Gy) in 50 1.2-Gy fractions if surgical margins were negative or 64.8 Gy in 54 1.2-Gy fractions if margins were positive. Two cycles of etoposide (50 mg/m(2) ) and cisplatin (50 mg/m(2) ) were given during RT, and another 3 cycles were given after RT. Eleven patients underwent prophylactic cranial irradiation (PCI).
  
  
  RESULTS
  The protocol completion rate was 78%. Gross total resection was accomplished in all 32 patients; 28% underwent R1 resection. Operative mortality was 0%. The most common surgical complication was postoperative pneumonia (25%). At a median follow-up time of 53.4 months (range, 2-154 months), the 2-year, 5-year, and 10-year rates of locoregional control were 84%, 76%, and 76%; distant metastasis-free survival, 52%, 48%, and 48%; disease-free survival, 49%, 45%, and 45%; and overall survival, 72%, 50%, and 45%, respectively. The brain was the most common site of distant failure (n = 5), but no patient who received PCI experienced brain metastasis.
  
  
  CONCLUSIONS
  Surgery followed by postoperative chemoradiation is safe and effective for the treatment of marginally resectable superior sulcus tumors.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Gomez
authors.forename: James D
authors.initials: JD
authors.lastname: Cox
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.forename: Xiong
authors.initials: X
authors.lastname: Wei
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Kim
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
mesh_terms: D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D010865:Pilot Projects; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome