Autologous Bone Marrow Transplantation (ABMT) and High-Dose Chemotherapy in Small Cell Lung Cancer

Abstract

Chemotherapy is accepted as the logical therapy for small cell lung cancer. The heterogeneity of this tumor combined with a fast doubling time and propensity to early metastatic spread make it a formidable opponent. Whereas combinations of cytostatic drugs have achieved impressive response rates in the last 10 years, when these response rates are dissected down into complete and less than complete only the former have been shown to benefit the patient [1]. Results have been reported in an incorrect and confusing manner in the majority of trials leading to overoptimism based on an overall response and ‘median survival’ times. As is too often the case with early reporting of results, the final results reveal the stark reality of long term survival statistics. Only a small number of patients treated with combination chemotherapy plus or minus local radiotherapy will achieve meaningful long term survival which may or may not be termed as cure. Those patients almost always have limited disease (that is limited to the thorax) and achieve complete remission rather quickly after chemotherapy. The converse is true that few patients with extensive disease have rarely achieved long term survival and no patient who only achieved partial remission survived 5 years.