Therapy for small cell and non-small cell lung cancer

This review addresses means for improving treatment results in small cell and non-small cell lung cancer. In small cell lung cancer lactate dehydrogenase and neuron-specific enolase seem to be important prognostic factors that may reflect not only tumor load but also growth rate. Chemotherapy seems to induce or select differentiated cells in small cell lung cancer, which focuses attention on other treatment modalities such as drugs, which can induce terminally differentiated nonproliferating cells. Scheduling of chemotherapy may improve survival, especially in extensive disease patients. Exciting new techniques for tumor targeting by a radiolabelled somatostatin-analogue and radiolabelled murine anti-epidermal growth factor are reported. The possible adverse effect of heterologous blood transfusions on survival after surgery of stage I and II non-small cell lung cancer remains a very important subject for investigation to solve the essential question whether the need for transfusion or the transfusion itself is the adverse prognostic factor. A possible improvement of survival of non-small cell lung cancer patients by chemotherapy should be investigated in patients with an excellent performance score and a small tumor load, eg, stage IIIa and IIIb patients. Neoadjuvant chemotherapy in such patients may improve survival but a better and especially more uniform design of the trials is urgently needed. Finally, the development of techniques to palliate terminally ill patients quickly and easily by reopening a closed bronchial lumen should be encouraged.