Surgery, BCG immunotherapy, and multichemotherapy in T3 stage-3 bronchogenic carcinoma

Thirteen consecutive unselected patients suffering from stage-3 bronchogenic carcinomas (12 with T3 tumors and one T2 primary bilateral simultaneous carcinoma) underwent surgical resection followed by intrapleural, deep upper bilateral intercostal injections and oral immunostimulation with living fresh Pasteur strains of bacillus Calmette-Guérin (BCG). Since the 30th postoperative day, patients were started on intermittent multichemotherapy with suboptimal doses of methotrexate, 5-fluorouracil, and cyclophosphamide associated with oral therapy with BCG. The length of survival in the "study group" was compared to the results observed in nine unselected, consecutive, and concomitant semirandomized patients with T3 stage-3 carcinomas treated with cobalt therapy plus identical immunochemotherapy (control group A). Comparison of results was also made with 69 out of 100 consecutive patients with T3 stage-3 unresectable carcinomas who survived longer than two months after exploratory thoracotomies (control group B), representing the natural course of unresectable cases. Twelve (92 percent) of the 13 patients in the study group survived longer than six months, ten (77 percent) survived more than 12 months, six (46 percent) lived 18 months or more, and five (37 percent) have surpassed the 24th month of survival to date. Differences in survival at 6, 12, 18, and 24 months and the average length of survival in the study group to date (19.1 months) are statistically significant when compared to control groups A and B. The quality of postoperative life measured by the performance status according to Karnofsky's scale demonstrates an average of 79.3 percent for the entire study group.