The purpose of this work is to evaluate the feasibility of combining preoperative radical irradiation and radical surgical extirpation in the management of bronchogenic carcinoma. This investigation is being carried out as a joint project of the Divisions of Radiotherapy and Thoracic Surgery at the University of Maryland Hospital. All patients admitted to the hospital with a diagnosis of lung cancer and with disease limited to one lung and the mediastinum are included, as well as cases which at previous thoracotomy were considered inoperable due to local extension of the tumor. Cases in which surgery was contraindicated by associated medical conditions have been excluded. Technic of Treatment In all cases a positive histologic diagnosis is obtained before initiation of therapy. If necessary, an exploratory thoracotomy is performed to obtain biopsies of the primary tumor and mediastinal nodes. Irradiation, in the form of cobalt-60 teletherapy, is then started. The minimum volume irradiated includes the primary tumor and the entire mediastinum. In anaplastic or oat-cell carcinomas both supraclavicular areas are also treated. In every case an effort is made to include all the areas to be treated in a single volume and to avoid irradiation of the opposite lung. The treatment is divided into two phases: 1. Initially, two parallel opposing fields are employed to cover the primary tumor and the mediastinum, and treatment is carried to a tumor dose of 4,500 r in four and a half weeks. The fields extend from the sternal notch to a level 8 cm. below the carina and are of adequate width to cover the primary tumor in the lung with at least 2 cm. margin. The minimum width of these fields is 10 cm. 2. Whenever possible, treatment is completed by means of rotation therapy to include the obvious residual tumor and adjacent mediastinum, with fields 10 to 12 cm. long and 7 to 9 cm. wide. An additional tumor dose of 1,500 r is delivered in about one week. In cases where rotation is not feasible because of the relative position of the primary tumor and the lymph nodes, small parallel opposing fields are used to complete the treatment. The supraclavicular fossae are treated with an anterior split field, extending from the mediastinal field to the middle of the neck. A given dose of 5,000 r is delivered in four weeks. Surgery is performed two months after completion of irradiation therapy. As in other regions of the body, we consider a waiting period of six to eight weeks advisable in order to allow for the full effect of irradiation to take place and for the subsidence of the acute tissue reaction. In addition, metastases present before the initiation of therapy usually will become clinically evident during this period and useless surgical procedures will be avoided. Results A total of 26 patients were included in this study (Table I). One-half of the patients were initially considered inoperable on the basis of previous thoracotomy or on clinical grounds.