Small cell carcinoma: combined approach to treatment.

Abstract

Fifty-six patients with untreated small cell carcinoma of the bronchus were treated with three courses of chemotherapy (cyclophosphamide, vincristine, and procarbazine and methotrexate) and assessed for response. Thirty-one patients (55-4%) were classified as responders; they were given a course of radiotherapy and were then randomly allocated to continued cyclical chemotherapy or no further chemotherapy until relapse. Non-responders to chemotherapy were treated with radiotherapy or palliatively. The median survival was 105 months in responders and 6 months in non-responders (P<001). The one-year survival in responders was 42%. There was no statistical difference in survival between patients treated with continued chemotherapy and those treated at relapse. Sixty-nine per cent of patients experienced no side effects from chemotherapy.Three indicators of non-response to chemotherapy were identified -exercise tolerance at diagnosis, macroscopic liver metastases, and inappropriate ADH secretion.Small cell carcinoma of the bronchus is a disseminated disease in most patients at presentation (Selawry, 1974). After reports of response and improved survival using radiotherapy (Miller et al, 1969), and chemotherapy we have tested whether a combination of chemotherapy and radiotherapy could be used to prolong useful life and whether prognostic factors could be identified. Methods

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients with limited stage small cell lung cancer

“…Gregor et al [1] and Lokich [3] also found consistently inferior median survival in patients with SIADH. But List [4] and Hainsworth et al [5] did not find any difference in survival among SIADH patients compared to the overall population of SCLC patients without SIADH.…”

“…Gregor et al [1] observed no objective tumor regression in five out of six hyponatremic patients with SCLC treated with COMP (cyclophosphamide, vincristine, methotrexate, procarbazine), compared with a 58% response rate overall among the patients without SIADH. However the series had not used modern chemotherapy and did not compare patients' clinical stage nor performance status.…”