Induction therapy of invading apical lung cancer

Six patients with invading apical lung cancer(IALC) underwent en bloc removal of the apical chest wall and underlying lung. Before surgery, the first two patients received only radiation therapy (RT) and the remaining 4 concurrent chemoradiation therapy (CCRT) with cisplatin based regimens. Two patients required resection of subclavian artery and vein. C6, 7 and T1 vertebral bodies and C7, 8 and T1 brachial nerves were resected in one patient. Pathological diagnosis revealed that viable tumor still remained in the resected specimens of the two patients with only RT, one of whom died of local recurrence 15 months postoperatively. However, no viable tumor was recognized in the 4 patients with CCRT, all of whom are alive from 7 to 15 months postoperatively without recurrence. These results suggest that CCRT is superior to RT as induction therapy of IALC.