[Bronchial cancer: from epidemiology to treatment]

The quest for an effective treatment for lung cancer is a major preoccupation for the medical community as it is now the leading cause of cancer mortality worldwide and its incidence continues to increase particularly in developing countries, in women and in patients under the age of 45 due to the high incidence of tobacco smoking. The major form of treatment for lung cancer is surgery whenever possible followed by chemotherapy either alone or in association with radiotherapy. The treatment of non-operable tumours can today be justified both by the slight but undeniable amelioration of survival rates and more importantly by an increase in the quality of life. Our experience, based on the treatment of 640 patients, suggests that the use of chemotherapy, which is legitimized by the high incidence of metastatic spread associated with the disease, leads to chemoresistant relapses in the case of small cell cancers and primary resistances in non-small cell cancer. Recent advances in the treatment of bronchial cancers are worth underlining as they have led to radical changes in daily practice. The efficacity of chemotherapy in the treatment of small cell cancers is based on a dose-effect relationship which justifies the use of induction therapy which, even if not particularly intensive, should be given at an optimal level. Moreover, thoracic radiotherapy is beneficial in the early stages of the disease. Chemotherapy increases the survival rates for patients with non small cell cancers and although this was difficult to demonstrate the effect is, today, widely accepted. Certain types of chemotherapy are oriented towards the optimisation of initial treatment with the aim of eradicating the microscopic metastatic disease (this is the case for chemotherapy intensification for small cell cancers and neo-adjuvant chemotherapy for non small cell cancers). Other strategies are aimed at maintaining a chemotherapy-induced tumoral response: possibly involving the use of interferons. Whilst thoracic oncology cannot promise exciting breakthroughs in the short-term, present phase III trials with new cytostatic drugs and new therapies give rise to real hopes for the future.