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J Thorac Cardiovasc Surg 2009;137:1379-1387
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Superior sulcus tumors with vertebral body involvement: A multimodality approach

^a Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
^b Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex
^c Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
^d Department of Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
^e Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Tex

Received for publication May 9, 2008; revisions received November 24, 2008; accepted for publication January 28, 2009.

^_* Address for reprints: David C. Rice, MD, Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 445, Houston, TX 77030. (Email: drice{at}mdanderson.org).

Objective: Superior sulcus tumors with involvement of the spine have historically been considered unresectable. We have previously documented a 2-year survival of 54% in patients treated with a multimodality approach. This work builds on our previous experience and examines the long-term outcomes.

Methods: A retrospective review was performed on patients with superior sulcus non–small cell lung cancer tumors with involvement of the vertebral column (n = 39) treated at The University of Texas MD Anderson Cancer Center from 1990 to 2006. Their clinical and pathologic data were analyzed for short- and long-term outcomes.

Results: Group 1 included 8 (21%) patients with neuroforamen or transverse process involvement, group 2 had 16 (41%) patients with partial vertebrectomy, and group 3 had 15 (38%) patients with total vertebrectomy. There were 2 (5%) postoperative deaths, and 11 (28%) patients had major complications. Margins were positive in 17 (44%) patients. Recurrence occurred in 23 (59%) patients and was local in 11 (28%) patients, distant in 11 (28%) patients, and both in 1 (3%) patient. Median time to local recurrence was 7 months in patients with positive margins and has not been reached for patients with negative margins (P = .007). Median, 2-year, and 5-year overall survival was 18 months, 47%, and 27%, respectively. On multivariate analysis, the only independent predictor of shorter survival was nodal metastases (P = .001; hazard ratio, 6.5; 95% confidence interval, 2.2–19.2).

Conclusion: An aggressive multimodality approach involving surgical resection can be performed with acceptable morbidity in highly selected patients with superior sulcus tumors and vertebral invasion at a specialized center. Encouraging long-term survival can be achieved in patients with negative margins and no lymph node involvement.