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Objective:  Rates of complete resection (50%) and 5-year survival (30%) for Pancoast tumors have not changed for 30 years.  However, combined modality therapy has improved outcome in other stage III non-small cell lung cancers.  This prospective intergroup trial tested the feasibility of concurrent induction chemoradiation and surgical resection in mediastinoscopy negative Pancoast tumors with the ultimate objective of improving resectability and overall survival.  Methods:  Patients with pathologically proven T3-4 NO-1 Pancoast tumors received 2 cycles of cisplatin and etoposide chemotherapy concurrent with 45 Gy radiation. In patients with no evidence of disease progression thoracotomy was performed 3-5 weeks later.  Two cycles of chemotherapy were given postoperatively.  Results:  From 4/95-9/99, 116 patients were entered on study. This analysis includes 101 eligible patients, 71 men and 30 women with a median age of 56 yrs.  Induction therapy was completed as planned in 93% patients with 2 Grade 5 and 17 Grade 4 toxicities(predominantly cytopenia).  To date, 81 patients have undergone thoracotomy with the most common procedure being lobectomy + chest wall resection.  1 patient died postoperatively.  A pathologic complete response (pCR) occurred in 57.5% patients and 63% tumors were downstaged.  At 1 year overall survival was 77% for T3, 80% for T4 tumors;  at 3 years 50% for both T3 and T4 tumors.  Most common site of relapse was the brain.  Conclusions 1)  This combined modality approach was highly feasible in a multi-institutional settings;  2) pCR rates were unexpectedly high;  3) resectability and overall survival are improved compared to historical controls;  4)  improved outcome was especially notable for T4 tumors which usually have grim prognosis.

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