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A prospective phase 2 study of surgery followed by chemotherapy and radiation for superior sulcus tumors
Author(s) -
Gomez Daniel R.,
Cox James D.,
Roth Jack A.,
Allen Pamela K.,
Wei Xiong,
Mehran Reza J.,
Kim Jae Y.,
Swisher Stephen G.,
Rice David C.,
Komaki Ritsuko
Publication year - 2011
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.26277
Subject(s) - medicine , chemotherapy , prospective cohort study , radiation therapy , sulcus , oncology , surgery , radiology
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. Cancer 2011;. © 2011 American Cancer Society.