Induction chemotherapy, concurrent chemoradiation, and surgery for Pancoast tumor. Mature results of a feasibility trial Short title: Multimodality treatment of Pancoast tumor

200 words] Traditional treatment of Pancoast tumor 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 tumor received induction chemotherapy (three courses of splitdose 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 to 6 weeks postradiation. Thirty-one consecutive patients with T3(81%) or T4(19%) Pancoast tumor 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 2and 5year survival rates of 74% and 46%, respectively. This intensive multimodality treatment of Pancoast tumor is feasible and improves local resectability rate and long-term survival as compared with historical series.