Background - Many oncologists have sow accepted a combined radiosurgic
al approach as the treatment of choice in patients with Pancoast tumou
r bur mast reports show an incorrect assessment of the disease. Method
s - Stage III lung cancer was classified as Pancoast tumour if the pul
monary extent was limited to the upper apical segment and if at least
one of the features of Pancoast syndrome, indicating tumour spread to
the para-apical structures, was present. Between 1984 and 1988 15 cons
ecutive patients were treated with primary radiotherapy followed by su
rgery or with primary excision and subsequent radiotherapy in the abse
nce of an initial histological diagnosis. Results - The mortality of p
atients given the combined treatment was 6.6% (one death due to pulmon
ary embolism), and the five year survival rate was 26.6% for all patie
nts and 57% for those who underwent complete resection without N2 dise
ase. Long term survival was 0% for those cases with incomplete resecti
on, N2 disease, or malignant invasion of the first rib. Conclusions -
Stage III lung cancer, classified as Pancoast tumour according to stri
ct, consistent criteria, is best treated by primary radiotherapy; comb
ined treatment should be used only for patients with potentially resec
table cancer without N2 disease and/or malignant invasion of the first
rib.