Patterns of Failure in Small Cell Lung Cancer: Implications for Therapy

Abstract

In recent years the management of patients with small cell lung carcinoma (SCLC) has undergone pronounced changes. Prior to 1970 surgery and radiotherapy constituted the most commonly applied forms of management. However, neither of these purely localised therapeutic modalities is capable of providing effective long-term disease control in the majority of patients (Broder et al. 1977; Bunn et al. 1977; Weiss 1978). Appreciation of the frequency and extent of metastatic disease (Bird et al. 1968; Eagan et al. 1973; Hansen and Muggia 1972) coupled with the sensitivity of SCLC to a variety of chemotherapeutic agents (Greco et al. 1978; Hansen 1982; Livingston et al. 1978) has led to the present emphasis upon the central role of systemic chemotherapy in patient management. Chemotherapy either alone or together with radiotherapy in combined modality schedules has resulted in high tumour response rates and a 4–5 fold prolongation of median survival (Hansen 1982). However, only 5%–10% of patients will achieve long-term disease remission. The majority of patients will relapse and die of their disease.