Background:
Primary tumors of the mediastinum and chest wall are heterogeneous in morphological structure, united only by anatomical localization. Considering their proximity to the vital structures of the mediastinum, their treatment is a complex task that requires a personalized approach in the selection of neoadjuvant therapy.

Material and methods:
The results of surgical, combined and complex treatment of 1,375 patients with primary malignant tumors of the mediastinum, and 98 patients with malignant tumors of the chest wall were analyzed. Various treatment methods were used in the neoadjuvant regime: radiotherapy, thermoradiotherapy, chemoradiotherapy and intra-arterial regional chemotherapy.

Results:
The results proved that the use of intra-arterial neoadjuvant chemotherapy (IACT) has a better degree of tumor regression (p<0.05) and the lowest frequency of metastases compared with the use of radiotherapy and thermoradiotherapy (p<0.001). When compared with the use of chemoradiation therapy, there were no statistically significant differences (p>0.05). The results of 3-year and 5-year survival rate did not have a statistically significant difference (p>0.05) between the variants of neoadjuvant therapy.

Conclusions:
In the treatment of patients with malignant tumors of the mediastinum and chest wall, the use of neoadjuvant therapy is mandatory. When a malignant tumor is localized in the anterior mediastinum, anterior and side wall of the chest, in the blood circulation zone of a. thoracica interna, a promising variant of neoadjuvant therapy is intra-arterial regional chemotherapy.