Induction chemotherapy, concurrent chemoradiation, and surgery for Pancoast tumour. Mature results of a feasibility trial

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

^* To whom correspondence should be addressed. E-mail: alexmarra{at}yahoo.it.

	Abstract

Traditional treatment of Pancoast tumour with local approaches - surgery, radiotherapy, or a combination of both, - leads to poor outcome because of high rate of uncomplete resection and lack of systemic control. Aim of the present prospective feasibility study was to determine whereas a trimodality approach improves local control and survival.

Patients with stage IIB to 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 acceler-ated radiotherapy). After restaging, eligible patients underwent surgery 4 to 6 weeks postradiation.

Thirty-one consecutive patients with T3- (81%) or T4- (19%) Pancoast tumour were enrolled in the study. Induction chemo-radiotherapy was completed in all patients without treatment-related deaths. Grade 3 to 4 toxicity was observed in 32% of cases. Twenty-nine (94%) patients were eligible for surgery. Complete resection was achieved in 94% of patients. Postoperative mortality rate was 6.4%, and major complications arose in 20.6% of patients. Median survival was 54 months with 2- and 5-year survival rates of 74% and 46%, respectively.

This intensive multimodality treatment of Pancoast tumour is feasible and improves local resectability rate and long-term survival as compared with historical series.

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