Carcinomas in the superior pulmonary sulcus produce "Pancoast's syndrome," involving pain in the shoulder and the ulnar distribution of the arm and hand, as well as Horner's syndrome. Careful evaluation and appropriate staging select the patients for preoperative irradiation (3000 rads) over a two- or three-week period. After a two- to four-week interlude, surgical resection of the chest wall, lower brachial plexus, and lung en bloc produces a five-year survival rate of over 30 per cent. Contraindications to this therapeutic approach include an excessive extension of the tumor into the neck or vertebrae, substantial mediastinal node metastases, and peripheral tumor dissemination.