**2. How does the treatment of pancoast tumours evolved the last decades**

For more than 40 years the treatment of Pancoast tumours has centred on a bi-modality regimen consisting of preoperative external beam radiotherapy followed by surgery. Trimodality treatment however with the addition of platinum based chemotherapy regimes has become currently the standard treatment, in order to achieve additive anti-tumour effects (chemotherapy as radiation sensitiser). According to Wright et al [14] induction chemoradiotherapy (CT/RT) can be administered with low morbidity, a higher complete resection rate, a high pathologic response rate, a reduced loco-regional recurrence rate and improved survival. Further improvement in radiotherapy with the advent of 3-dimensional conformal radiotherapy, the total radiation dose that could be safely delivered was not anymore con‐ strained by dose-limiting toxicities upon the nearby organs.

Careful patient selection for tri-modality treatment, on the basis of staging and comorbidity, is of vitalimportanceinthetreatmentofPancoasttumours.Neverthelessonly30%ofM0patientswith Pancoast tumours were eligible for combined treatment according to Pourel et al [15]. Not only operability (patient fitness to surgery) but also ability to resect the tumour is of a major impor‐ tancebearinginmindthedifficultyofaccess,thecrowdedanatomyofthisregionandthetendency of the tumours in this area to involve important adjacent structures. As per the same group [15], following CT/RT, 67% of the patients were amenable to thoracotomy. The resection rate, which had remained unchanged at approximately 50%for almost 40 years with conventional preopera‐ tive radiotherapy, was improved to above 70% in SWOG [16] and JCOG [17] studies.

Preoperative radiotherapy was part of the standard treatment, but a recent prospective phase II study (Southwest Oncology Group 9416, INT 0160)[16], suggests that preoperative concur‐ rent CT/RT (platinum-based chemotherapy and 45Gy of radiotherapy) improves the rate of complete resection, local recurrence, and intermediate-term survival. Like wise, the Japan Clinical Oncology Group JCOG trial 9806 [17]in a prospective report concluded along the same lines. Furthermore, Kwong et al [18] reported that high dose radiotherapy targeting up to 60 Gy (rather than 45 Gy) could be given in the neoadjuvant setting; it is successfully tolerated and associated with improved resection rate.
