Summary
Recent results of ongoing multicenter cooperative studies on patients treated with multimodality therapies of small-cell bronchial carcinoma are used as an example to demonstrate the definite progress of treatment results. This was possible only after a gradual development of aggressive intermittent long-term chemotherapy by different combinations of cytostatic drugs combined with various other kinds of therapy during the last three decades. The evaluation of results was only feasible after a step-by-step development of the international uniform pTNM staging system. This example is also useful to demonstrate the possible increased impact of these results, in spite of a very selected small number of patients, on the overall statistical survival with the assumption that the evaluable methods will be applied by a greater number of cooperative groups and in general practice. The life-table curves of pTNM-I-staged patients show a plateau of over 60% for the 4-year-survival rate, demonstrating much better results by comparison with non-surgical combined modality (radio- and chemotherapy) treatments. They are also much better than generally expected, which in turn demonstrates the great discrepancy in importance between the results from a scientific theoretical and a practical point of view. Only since the TNM staging system was developed has it been possible to distinguish the stages based on clinical diagnostic procedures, with a lower grade of certainty, from those with the precise pTNM staging based on the pathohistological findings.
Abbreviations
- SCLC:
-
small-cell lung carcinoma
References
Aisner J (1989) Should we intensify the treatment of small cell lung cancer? Chest 96: 64–66
Bleehen NM, Fayers PM, Girling DJ, Stephens RJ (1989) Controlled trial of twelve versus six courses of chemotherapy in the treatment of small-cell lung cancer. Report to the Medical Research Council by its Lung Cancer Working Party. Br J Cancer 59:584–590
Cullen MH (1989) Optimum duration of treatment with combination chemotherapy for small cell lung cancer. Chest 96:62–64
Denk W, Karrer K (1955) Modellversuch einer Rezidivprophylaxe des Karzinoms. Wien Klin Wochenschr 67:986
Denk W, Karrer K (1961) Combined surgery and chemotherapy in the treatment of malignant tumours. Cancer 14:1197–1204
Elliott JA, Osterlind K, Hansen HH (1984) Cyclic alternating “noncross resistant” chemotherapy in the management of small cell anaplastic carcinoma of the lung. Cancer Treat Rev 11:103–113
Frei E III (1985) Curative cancer chemotherapy. Cancer Res 45:6523–6537
Gazdar AF, Bunn PA Jr, Minna JD, Baylin SB (1985) Origin of human small cell lung cancer. Science 229:679–680
George SL (1988) Identification and assessment of prognostic factors. Semin Oncol 15:462–471
Ginsberg RJ, Karrer K (1989) Surgery in small cell lung cancer: a consensus report. Lung Cancer 5:139
Greenberg ER, Chute CG, Stukel T, Baron JA, Freeman DH, Yates J Korson R (1988) Social and economic factors in the choice of lung cancer treatment. N Engl J Med 318:612–617
Karrer K (1979) Adjuvant chemotherapy of postsurgical minimal residual bronchial carcinomas. In: Bonadonna G, Mathé G, Salmon SE (eds) Recent results. Cancer Res 68:246-259
Karrer K, Mannheimer E (1973) Hämatologische Erfahrungen bei zytostatisch bedingter Leukopenie und autologer Knochenmarksreinfusion. Wien Innere Med 54:51–68
Karrer K, Humphreys SR, Goldin A (1967) An experimental model for studying factors which influence metastasis of malignant tumours. Int J Cancer 2:213–223
Karrer K, Pridun N, Denck H (1978) Chemotherapy as an adjuvant to surgery in lung cancer. Cancer Chemother Pharmacol 1:145–159
Karrer K, Denck H, Pridun N (1983) Combination of early surgery for cure and polychemotherapy in small cell bronchial carcinoma. Spitzy KH, Karrer K (eds) Proceedings of 13th International Congress of Chemotherapy, Vienna 1983. Egermann, Vienna. Tom 11:228/52–60
Karrer K, Shields TW, Denck H (1989) The importance of surgical and multimodality treatment for small cell bronchial carcinoma. J Thorac Cardiovasc Surg 97:168–176
Karrer K, Denck H, Karnicka H, Drings P, Salzer GM, Orel J (1990) Multimodality treatment starting with surgery for cure of small cell bronchial carcinoma (SCLC). In: Salmon SE (ed) Adjuvant therapy of cancer, vol VI. Saunders, Philadelphia, pp 154–161
Killion JJ, Fidler IJ (1989) The biology of tumor metastasis. Semin Oncol 16:106–115
Lee JS, Murphy WK, Glisson BS, Dhingra HM, Holoye PY, Hong WK (1989) Primary chemotherapy of brain metastasis in small-cell lung cancer. J Clin Oncol 7:916–922
Leonard RCF (1989) Small cell lung cancer. Br J Cancer 59:487–490
Meyer JA (1987) Indications for surgical treatment in small cell carcinoma of the lung. Surg Clin N Am 67:1103–1115
Naruke T, Goya T, Tsuchiya R, Suemasu K (1988) Prognosis and survival in resected lung carcinoma based on the new international staging system. J Thorac Carciovasc Surg 96:440–447
Oldham RK, Greco FA (1980) Small-cell lung cancer. Cancer Chemother Pharmacol 4:173–177
Salazar OM (1989) Combined modality treatment of small cell lung cancer. Chest 96:74–78
Shields T, Matthews M (1984) Adjuvant therapy of small cell bronchial carcinoma. Cancer Treat Rev 11:331–333
Spiro SG, Souhami RL, Geddes DM, Ash CM, Quinn H, Harper PG, Tobias JS, Partridge M, Eraut D (1989) Duration of chemotherapy in small cell lung cancer: a Cancer Research Campaign trial. Br J Cancer 59:578–583
UICC (1987) TNM Classification of malignant tumours, 4th edn, Hermanek P, Sobin LH (eds). Springer, Berlin, Heidelberg, New York
UICC (1989) TNM atlas. Illustrated guide to the TNM/pTNM-classification of malignant tumours, 3rd edn, Spiessl B (ed). Springer, Berlin, Heidelberg, New York
Ulsperger E, Shields TW, Karrer K (1990) The role of surgery in small cell lung cancer. Lung Cancer (in press)
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The “Journal of Cancer Research and Clinical Oncology” publishes in loose succession “Editorials” and “Guest editorials” on current and/or controversial problems in experimental and clinical oncology. These contributions represent exclusively the personal opinion of the author
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Karrer, K. Is the progress in cancer treatment results adequate or are we confronted with a more or less worldwide stagnation?. J Cancer Res Clin Oncol 116, 425–430 (1990). https://doi.org/10.1007/BF01612987
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DOI: https://doi.org/10.1007/BF01612987