Advances in small cell bronchogenic carcinoma
Bunn, P.A.; Cohen, M.H.; Ihde, D.C.; Fossieck, B.E.; Matthews, M.J.; Minna, J.D.
Cancer Treatment Reports 61(3): 333-342
1977
ISSN/ISBN: 0361-5960 PMID: 194690 Document Number: 116460
All lung cancer patients should have slides reviewed by a pathologist familiar with a WHO oriented classification system. Serial measurements of levels of marker substances to determine their value in assessing completeness of remission and early relapses should be performed. Routine staging procedures should include evaluation of liver, bone, bone marrow, and brain. Other staging procedures including peritoneoscopy, lymphangiography and radionuclide scanning should be further evaluated in clinical investigation protocols. The prognostic importance of metastases to each organ should be determined. Bronchoscopy is a useful tool for evaluating response to therapy. Extent of disease, age, sex, performance status, prior therapy and immune status should be reported in all trials. Surgery appears to have little value except in peripheral solitary nodules. Adjuvant chemotherapy should be studied in these cases. Chemotherapy plus radiotherapy is superior to radiotherapy alone, even in limited disease. When effective combination chemotherapy is used, radiotherapy to the chest does not clearly increase survival over chemotherapy alone. Prophylactic CNS therapy with cranial irradiation or a systemic nitrosourea is useful in reducing brain metastases. Despite the increased response rates and survivals attributed to combination chemotherapy with or without radiotherapy, few patients are cured and long periods of treatment are necessary. New chemotherapeutic and radiotherapeutic tactics are necessary for further improvements. Increasing the intensity of induction therapy has led to considerable increases in response rate, survival and toxicity.