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Induction chemotherapy, concurrent chemoradiation and surgery for Pancoast tumour

¹ Dept of Thoracic Surgery and Endoscopy, Ruhrlandklinik, Depts of ² Internal Medicine (Cancer Research), ³ Radiotherapy, and ⁴ Pathology, West German Cancer Center, University of Essen Medical School, Essen, Germany.

CORRESPONDENCE: A. Marra, Dept of Thoracic Surgery and Endoscopy, Ruhrlandklinik, Tueschener Weg 40, 45239 Essen, Germany. Fax: 49 2014332009. E-mail: alexmarra{at}yahoo.it

Keywords: Chemotherapy, lung cancer, neoadjuvant therapy, radiotherapy, surgery

Received: September 14, 2005
Accepted August 17, 2006

The traditional treatment of Pancoast tumour with local approaches (surgery, radiotherapy or a combination of both) leads to a poor outcome due to the high rate of incomplete resection and the lack of systemic control. The aim of the present prospective feasibility study was to determine whether a trimodality approach improves local control and survival.

Patients with stage IIB–IIIB Pancoast tumour received induction chemotherapy (three courses of split-dose cisplatin and etoposide or paclitaxel) followed by concurrent chemoradiotherapy (a course of cisplatin/etoposide combined with 45 Gy hyperfractionated accelerated radiotherapy). After restaging, eligible patients underwent surgery 4–6 weeks post-radiation.

A total of 31 consecutive patients with T3 (81%) or T4 (19%) Pancoast tumour were enrolled in the study. Induction chemoradiotherapy was completed in all patients without treatment-related deaths. Grade 3–4 toxicity was observed in 32% of cases. In total, 29 (94%) patients were eligible for surgery. Complete resection was achieved in 94% of patients. The post-operative mortality rate was 6.4% and major complications arose in 20.6% of the patients. The median survival was 54 months with 2- and 5-yr survival rates of 74 and 46%, respectively.

In conclusion, this intensive multimodality treatment of Pancoast tumour is feasible and improves local resectability rates and long-term survival as compared with historical series.