Twelve patients with non-small cell lung cancer had tumors that were adherent to the vertebral column and clinically suspected of invading the bone. All were free of mediastinal node involvement as assessed by pretreatment mediastinoscopy. All received 3000 rads of preoperative radiation followed by en bloc resection of the lung and a tangential portion of the involved vertebral bodies. A complete mediastinal lymphadenectomy was also performed. Three patients had true Pancoast's syndrome and in the remaining nine the tumor was located above T6 with the majority in the apex of the chest. Resectability was based on the absence of tumor extension into the costotransverse foramen and the extent of vertebral body involvement. Detailed studies of the decalcified surgical specimen show that the tumor extended into the cortex in two patients, periosteum in six, parietal in three, and up to the visceral pleura in one. Six patients are alive after 1 to 11 years (four beyond 5 years) without evidence of recurrent tumor and arthritic pain. The overall 5- and 10-year survival rate (Kaplan-Meier method) was 42%. In patients with tumors adherent to the vertebral body and no evidence of roentgenographic erosion, the en bloc removal of the lung and the involved portion of the vertebral body is required for complete excision and is associated with long-term survival without sequelae.