Integrated irradiation and surgery in the treatment of apical lung cancer

From 1938 through 1968, 106 patients with previously untreated apical lung cancer were seen at Memorial Hospital. Eleven patients have survived for 5 years or more, a 5-year survival rate of almost 10%. Of 13 additional patients seen during the same period after definitive treatment elsewhere, none have survived for 5 years. Preoperative irradiation followed by complete resection of the tumor is the most beneficial procedure and worthy of further trial. However, only 9% of the explored patients had a complete resection at Memorial Hospital. Interstitial implants at thoracotomy are most valuable for those patients with unresectable lesions resulting in a 5-7ear survival rate of 16%. The combination of resection of the parenchymal cancer and implantation of the chest wall residual disease yielded a 5-year survival rate of about 30%. Finally, external radiation therapy for patients with inoperable apical lung cancer resulted in a 5-year survival rate of 5%.