Cure rates in small cell and non-small cell carcinoma of the lung utilizing high-dose radiotherapy and chemotherapy.

From 1967 to 1977, 72 patients with small cell carcinoma of the lung were seen. Thirty-five of these patients had unilaterally localized lesions (limited disease) and were treated with cobalt 60 radiation therapy (6,000 rad in six weeks) followed by chemotherapy consisting of cyclophosphamide (Cytoxan), vincristine, methotrexate and lomustine (CCNU) (Group A). The remaining 37 patients with extensive disease were treated with similar chemotherapy alone, or in combination with local palliative radiotherapy to the symptomatic area (Group B). For Group A the five-year survival rate was 20 percent, while for both groups combined, it was only 5 percent.During this same period 560 patients with non-small cell carcinomas were treated. The five-year survival rate for those patients with operable, resectable lesions was 33 percent, while for those with unilateral, inoperable, unresectable lesions, it was 10 percent. Thus, it would appear that the results in limited small cell and non-small cell carcinomas of the lung utilizing high-dose radiotherapy followed by chemotherapy are comparable, and that limited small cell carcinoma of the lung patients with high-dose radiotherapy followed by chemotherapy can survive longer than those patients with stage III, non-small cell lung carcinoma.While the two- to five-year survival rates in small cell carcinoma demonstrate no appreciable differences, in non-small cell carcinomas there are significant two- to five-year survival differences. These improved results probably are due to the increased sensitivity of small cell carcinoma to high-dose local radiotherapy and to the chemotherapeutic vulnerability of circulating and microscopic metastatic cancer cells.