Treatment of small cell carcinoma of the lung

Current strategies for treatment of small cell carcinoma of the lung are based on the concept of the disease as a systemic condition, requiring systemic treatment. Small cell carcinoma is considerably more sensitive to anticancer drugs than other bronchogenic neoplasms. The most widely used agents are cyclophosphamide, adriamycin, vincristine, CCNU, methotrexate, and VP 16-213. The superiority of combination chemotherapy over single drug treatment has been documented in prospective randomized trials. With suitable drug regimens, partial or complete remissions can be achieved in 80-90% of untreated cases, resulting in three- to five-fold prolongation of median survival. Radiotherapy may improve control of intrathoracic disease and reduce the incidence of cerebral metastases but this treatment does not increase median survival. In spite of impressive initial responses, long-term results are disappointing, with a 2-year disease-free survival rate of approximately 5 to 10%. Improvement of treatment results may be expected from the use of sequential combination chemotherapy with drugs administered at maximally tolerated doses. A high intensity of treatment calls for increased attention to supportive measures against infections and other complications. The ultimate role of surgery, brain and/or chest irradiation, and immunotherapy as adjuvants to chemotherapy remains to be defined.