A retrospective analysis of 35 patients treated for superior sulcus tumors of the lung at UCLA was performed for the years 1960-1983. Follow-up ranged from 19 months to 21 years, with all but one patient followed at least 2 years. The 28 patients with localized disease were treated by megavoltage irradiation with or without surgical resection and had a 5-year survival (product-limit) of 21%. However, the 15 patients receiving combined treatment had a 48% 5-year survival (p = 0.009). An effort was made to identify those factors affecting survival. Patients presenting with no radiographic evidence of nodal enlargement appeared to have a survival advantage with a survival of 31% at 3 years, versus no survivors among those with positive nodes (p = 0.059). Bony erosion contiguous with the primary tumor at presentation was found not to affect the prognosis. Patients with local control of the primary tumor showed a survival of 71% vs 0% for those locally recurring. Those patients receiving at least 55 Gy showed a trend toward increased survival though not with statistical significance. The pattern of failure was evaluable in 25 patients. Local recurrence was observed in 18 patients (72%) with seven (39%) of these manifesting as spinal cord compressions. Distant metastases were seen in 35% of recurrences, and as the sole site of disease in only 10%. Three patients developed brain metastases, all of whom had concomitant local failure. Significant pain relief was achieved in 74% of patients. However, it was transient in 60% of these. We conclude that superior sulcus tumors remain primarily a localized problem, and that aggressive treatment is indicated even with apparently local invasive disease.