In the 1950s, supraglottic sulcus tumors were considered insensitive to radiotherapy and were also considered off-limits for surgery, but their treatment has evolved considerably in recent years. Imaging allows for better visualization of the extent and size of the tumor and its relationship to surrounding structures. With advances in surgical management techniques, we are better able to manage tumors involving the anterior thoracic inlet and subclavian vessels. The same sophisticated spinal surgical techniques can help manage tumors involving the spine. Supraglottic sulcus tumor – Overview Supraglottic sulcus tumors are primary lung cancers that originate in the apical lung and invade the lower portion of the brachial plexus nerve, the ribs and vertebrae of the upper chest, as well as the stellate ganglion and subclavian vessels and nerves. The characteristic manifestations of supraglottic sulcus tumor are pain along the shoulder, upper extremity, Homer’s syndrome, muscle atrophy of the hand and a shadow in the apical region of the lung on chest radiograph. There have been two revolutionary advances in the treatment of supraglottic sulcus tumors. The first was the introduction of radiation therapy for supraglottic sulcus tumors by Haas et al. The second advance was the postoperative adjuvant radiation therapy after surgery pioneered by Chordack. Thereafter, Sham et al. adopted preoperative radiation + radical resection as the standard treatment modality. The complete resection rate (50%) and 5-year survival rate (30%) of supraglottic sulcus tumors have remained essentially unchanged over the years, and with the application of combined treatment modalities in recent years, the complete resection rate and 5-year survival rate of supraglottic sulcus tumors have improved.