Small cell anaplastic carcinoma of lung. Reappraisal of current management

The relative roles of radiotherapy, intensive chemotherapy, and a combination of both were evaluated by an analysis of 157 of 188 patients who were registered at Tumor Registry and the Department of Radiation Medicine at Massachusetts General Hospital with a diagnosis of small cell anaplastic carcinoma of the lung between 1968 and 1974. Stage of the tumor was the single most important prognostic factor. Bone marrow involvement was found in 29% of patients studied. For extensive tumor, better survival was obtained by a combination of intensive chemotherapy and radiotherapy than with radiotherapy alone. However, no improvement of survival was noted with combination of concomitant or sequential intensive COPP or COP chemotherapy and radiotherapy over that obtained with radiotherapy followed by subsequent chemotherapy for progressive disease in patients with localized tumor. For localized tumor, primary radiotherapy should be given with an intention of local control or cure. Conclusions regarding the proper timing of chemotherapy and radiotherapy in apparently localized small cell anaplastic carcinoma require further prospective evaluation.