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Our patient was a 67-year-old man. In the previous two months he had noticed a small mass in the sternal end of the clavicle; this was hard in consistency and painless and had rapidly increased to reach the size of an egg (Fig. 1). Physical examination revealed that the neoplasm was attached to the clavicle and manubrium sterni. The sedimentation rate was high (KI=81).Radiographs showed an osteolytic lesion of the sternal end of the left clavicle and of the manubrium (Fig. 2). Bronchography, barium study, mesenteric angiograms, urography, and isotopic study of the liver and thyroid were non-contributory.Resection of the manubrium, the inner third of the left clavicle, and the sternal end of both the first two ribs was performed. Two split tibial grafts, each 8 cm long, were sutured with steel wire to the resected ends of the first and second ribs in order to close the defect in the anterior chest wall (Fig. 3). The pectoralis muscles and subcutaneus tissues were drawn together in the midline to cover the autogenous grafts. A drainage tube was placed in the subcutaneous space and the skin was closed.The patient had an uneventful postoperative course without paradoxical respiration (Fig. 4).Histological examination revealed a highly undifferentiated metastatic carcinoma of uncertain origin. Further search for the primary tumour was unsuccessful. The patient is well 10 months after the operation. 350 on 9 May 2018 by guest. Protected by copyright.

Twenty patients with stage IIIA-IIIB non-small-cell lung cancer were treated with cisplatin, epirubicin and VP-16 (PEV) neoadjuvant chemotherapy (CDDP, 70 mg/m2, i.v., d 1; EDX, 60 mg/m2, i.v., d 1; VP-16, 100 mg/m2, i.v., d 1-2-3; every 3 weeks). A partial response was obtained in 11 cases (55%), stable disease in 3 cases (15%), and progressive disease in 6 cases (30%). After chemotherapy, 8 (40%) patients, all achieving a partial response, were elegible for surgery: 5 (25%) had a complete resection (4 IIIA and 1 IIIB) and 3 (15%) an incomplete resection. The treatment was well tolerated. These data show that PEV is an active regimen for neoadjuvant chemotherapy in NSCLC and recommend this therapeutic approach for stage IIIA patients.