title: Results of surgical resection after induction chemoradiation for Pancoast tumours †.
abstract: OBJECTIVE
  Pancoast tumour is a rare neoplasia in which the optimal therapeutic management is still controversial. The traditional treatment of Pancoast tumour (surgery, radiotherapy or a combination of both) have led to an unsatisfactory outcome due to the high rate of incomplete resection and the lack of local and systemic control. The aim of the study was to determine the efficacy of the trimodality approach.
  
  
  METHODS
  Fifty-six patients (male/female ratio: 47/9, median age: 64 years) in stage IIB to IIIB were treated during a period between 1994 and 2013. Induction therapy consisted of 2-3 cycles of a platinum-based chemotherapy associated with radiotherapy (30-44 Gy). After restaging, eligible patients underwent surgery 2 to 4-week post-radiation.
  
  
  RESULTS
  Thirty-two (57.1%) patients were cT3 and 24 (42.9%) cT4, 47 (83.9%) were N0 and 9 (16.1%) N+. Forty-eight (85.7%) patients underwent R0 resection and 10 (17.9%) had a complete pathological response (CPR). Thirty-day mortality rate was 5.4%, major surgical complications occurred in 6 (10.7%) patients. At the end of the follow-up, 17 (30.4%) patients were alive and 39 (69.6%) died (29 for cancer-related causes), with an overall 5-year survival of 38%. At statistical analysis, stage IIB (P = 0.003), R0 resection (P = 0.03), T3 tumour (P = 0.002) and CPR (P = 0.01) were significant independent predictors of better prognosis.
  
  
  CONCLUSIONS
  This combined approach is feasible, and allows for a good rate of complete resection. Long-term survival rates are acceptable, especially for early stage tumours radically resected. Systemic control of disease still remains poor, with distant recurrence being the most common cause of death.
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy beppemarulli@libero.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Battistella
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Breda
authors.affiliation: Department of Oncology, Istituto Oncologico Veneto, Veneto, Italy.
authors.forename: Adolfo Gino
authors.initials: AG
authors.lastname: Favaretto
authors.affiliation: Department of Oncology, Istituto Oncologico Veneto, Veneto, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pasello
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zuin
authors.affiliation: Department of Radiotherapy, Istituto Oncologico Veneto, Veneto, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Loreggian
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Schiavon
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Unit, University of Padova, Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009367:Neoplasm Staging; D010178:Pancoast Syndrome / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chest wall; Induction therapy; Pancoast tumour; Superior sulcus tumour