Small-cell carcinoma of the lung: A five-year experience with combined modality therapy

Abstract

In the past five years, we have treated 89 patients with small-cell carcinoma of the lung with radio-therapy plus one of three chemotherapy programs. The 24 patients with disease confined to the chest (Stage IIIMo) had an 87% response rate to the combined modalities (79% complete responses) and a median survival of 18 months; 13 patients with disease confined to the chest and ipsilateral supraclavic-ular nodes (Stage IIIMoSCN+) had an 84% response rate (69% complete reponses) and 11-month median survival; the 52 patients with distant metastases (Stage IIIMI) had a 71% response rate (15% complete responses) and eight-month median survival. Survival was not affected by adding pro-phylactic cranial irradiation to the latest regimen, although the CNS relapse rate was reduced. We conclude that our three chemotherapy programs to date differ very little in their effect on survival of patients with metastatic disease. New and more vigorous approaches, possibly including surgery, need to be tested for the management of disease confined to the chest. The designation of patients as Stage III,,SCN+ is valid because such patients have better survival rates than patients with distant metastatic disease. Cancer 46:2550-2556. 1980. MALL-CELL CARCINOMA of lung is a disease S with very poor survival rates and for which the local modalities of surgery and radiotherapy have little impact on mortality.25 In the past decade, major advances have been made in the management of this tumor, principally due to the addition of combination chemotherapy programs to local modalities of treatment. These advances have been summarized in several recent reviews.7~16~23~27 Beginning in 1974, patients at the University of Chicago and Michael Reese Medical Center with small-cell bronchogenic carcinoma have been treated aggressively with a series of three successive programs combining radiation therapy and chemotherapy. Our results with 51 patients with two of the programs have been reported previously.5,10 In this paper we report the results of treatment of 38 additional patients with a third program, compare the three programs, and sum