321SAFETY AND EFFECTIVENESS OF CONCOMITANT INDUCTION CHEMO-RADIATION FOLLOWED BY SURGICAL RESECTION FOR PANCOAST TUMOUR

Objectives: 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) leads 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 patients (male/female ratio: 44/6, median age: 63 years) in stage IIB to IIIB were prospectively treated during a period between 1994 and 2009. Induction therapy consisted of 3 cycles of a platinum-based chemotherapy associated with radiotherapy (30–44 Gy). After restaging, eligible patients underwent surgery 3–4 weeks post-radiation. Results: Thirty (60%) patients were T3 and 20 (40%) T4, 43 (86%) were N0 and 7 (14%) N+. Forty-four (88%) patients underwent R0 resection and 7 (14%) had a complete pathologic response (CPR). Thirty-day mortality rate was 6%; perioperative complications occurred in 26%. At the end of follow-up, 18 (36%) patients were alive and 32 (64%) died (25 for cancer-related causes; 84% distant metastases), with an overall 5-year survival of 38%. Following statistical analysis, stage IIB (P = 0.02), R0 resection (P = 0.02), T3 tumour (P = 0.009) and CPR (P = 0.01) were significant predictors of better prognosis. Conclusion: 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 the disease still remains poor, with distant recurrence being the most common cause of death.