THE MEDICAL-TREATMENT OF LUNG-CANCER

In the treatment of bronchogenic carcinoma approaches vary depending upon whether the carcinoma in question is defined as a small cell or a non-small cell lung cancer. Small-cell lung cancer in the majority of cases must be seen as a systemic disease even with an early diagnosis. Because of this, chemotherapy is the dominant form of treatment. For patients with limited disease radiotherapy and surgery are additionally recommended as potentially curative measures, and for those with extensive disease, surgery and radiotherapy may serve as palliative treatment. Chemotherapy generally consists of a combination of two or more cytostatic drugs. As a rule 4 to 6 treatment cycles are administered. Maintenance therapy appears to be of little value. In case of tumor relapse, new cytostatic combinations can be attempted or the cytostatic regimen which was originally successful can be reintroduced. Whether or not a tumor responds to a particular chemotherapy is apparent after the first cycle of treatment. When the tumor shows no reduction in small-cell lung cancer, the treatment regimen can immediately be changed. The question of possible intensification of induction chemotherapy has yet to be clarified by clinical trials. The data gathered thus far, however, suggest that there is no measurable improvement in survival rates when chemotherapy is intensified beyond standard practice. In the case of non-small cell lung cancer, the disease is predominantly characterized by locally limited tumor growth, so that radiotherapy and surgery are initially the preferred forms of treatment. Systemic therapy in non-small cell lung cancer has thus been mainly reserved for the stage of tumor dissemination (stage IV). For these patients chemotherapy has proved generally to have a purely palliative effect which is of limited duration. Recent clinical trials indicate, however, that better results can be obtained when chemotherapy is applied in stage III. These encouraging results stem from a number of clinical studies, in which polychemotherapy containing cisplatin (with or without radiotherapy) was applied preoperatively to initially inoperable stage III non-small cell lung cancer patients. It must be noted, however, that up until now these positive results have been achieved mainly in uncontrolled clinical investigations which must be confirmed by larger controlled trials.