External radiation in the management of superior sulcus tumor

Thirty-one patients with superior sulcus tumor (Pancoast's syndrome) treated with radiation between 1967 and 1980 were reviewed. Doses ranged from 2000 to 7000 cGy delivered with a continuous schedule (23 patients) and a split course regimen (8 patients). The overall survival at 5 years was 18% (median, 17 months). Patients without bone erosion or scalene lymph node involvement (13 patients) had the best 5-year survival rate of 40%. Local control tended to correlate with the total dose and tumor extent; doses below 5000 cGy or bone invasion were associated with a higher rate of local failure. Primary external radiation is not only useful for palliation but can also cure some patients with superior sulcus tumor.