Trial of Pre-operative Chemoradiotherapy Followed by Surgical Resection in Pancoast Tumors (JCOG 9806)

Pre-operative radiotherapy has long been the community standard in Pancoast, or superior sulcus tumor. However, both complete resection rate (-50%) and long-term survival (-30%) are poor and unchanged for 40 years. Concurrent chemoradiotherapy has been shown to be beneficial in unresectable stage III non-small cell cancer. Surgery after induction chemoradiotherapy thus is a promising treatment strategy, and in fact, SWOG reported favorable results of this trimodality approach in superior sulcus tumor. The current trial is a Japanese, cooperative, multi-center, prospective one to evaluate its safety and efficacy.

Inclusion criteria

• Newly diagnosed, pathologically documented non-small cell lung cancer (NSCLC)
• Invasion to the first rib or more superior chest wall
• Age: 15-74 years old
• Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
• Ample organ function
• No prior chemo- or radiotherapy
• Signed informed consent

Exclusion criteria

• Metastasis to, or involvement of, mediastinal node (N2)
• Distant metastasis or dissemination to pleura/pericardium
• Active concomitant malignancy
• Unstable angina, recent myocardial infarction, heart failure
• Uncontrolled diabetes or hypertension
• Pregnant or lactating women
• Other severe complications