The Potential Role of Surgery in the Contemporary Combined Modality Management of Small Cell Anaplastic Lung Cancer

  • Robert L. Comis
Part of the Cancer Treatment and Research book series (CTAR, volume 11)


Prior to the development of a variety of moderately effective chemotherapeutic agents the only modalities available for the treatment of small cell anaplastic lung cancer (SCALC) were the local modalities of surgery and radiotherapy. Trials performed with local modalities as the sole method of therapy were instrumental in establishing the virulent nature of this disease and its propensity for early dissemination. The 3–5-year survival rates observed in patients treated with surgery or radiotherapy alone ranged from zero to a maximum of 5% for patients with disease apparently limited to one hemithorax [1–5]. The lack of an association between the clinical stage of intrathoracic disease and survival led to an abandonment of the TNM staging system for SCALC [5]. Subsequently, the Veterans Administration Lung Cancer Study Group (VALSG) established a functional staging system which grouped patients into limited disease (confined to one hemithorax and/or the ipsilateral supraclavicular node) and extensive disease (outside the confines of limited disease) categories. The median survival times for placebo treated limited and extensive disease patients were 3 months and 6 weeks, respectively [6, 7].


Small Cell Lung Cancer Combination Chemotherapy Small Cell Carcinoma Limited Disease Bronchogenic Carcinoma 
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  1. 1.
    Bergsagel D, Jenkins R, Pringle J, et al.: Lung cancer: clinical trial of radiotherapy alone versus radiotherapy plus cyclophosphamide. Cancer 30:621–727, 1972.PubMedCrossRefGoogle Scholar
  2. 2.
    Fox W, Scadding JG: Medical Research Council comparative trial of surgery and radiotherapy for the primary treatment of small celled or oat cell carcinoma of the bronchus. Ten year follow-up. Lancet 2:63–65, 1973.PubMedCrossRefGoogle Scholar
  3. 3.
    Laing AH, Berry RJ, Newman CR: Treatment of small cell carcinoma of the bronchus. Lancet 1: 129–132, 1975.PubMedCrossRefGoogle Scholar
  4. 4.
    Lee RE, Carr DT, Childs DS: Comparison of split course radiation therapy and continuous radiation therapy for unresectable bronchogenic carcinoma: 5 year results. Am J Roentgenol Radium Ther Nuc Med 126: 116–122, 1976.Google Scholar
  5. 5.
    Mountain CF: Clinical biology of small cell lung cancer: Relationship to surgical therapy. Sem Oncol 5: 272–279, 1978.Google Scholar
  6. 6.
    Green RA, Hymphrey E, Close HM, et al.: Alkylating agents in bronchogenic carcinoma. Am J Med 46:516–525, 1969.PubMedCrossRefGoogle Scholar
  7. 7.
    Zelen M: Keynote address on biostatistics and data retrieval. Cancer Chemother Rep 4: 31–42, 1973.Google Scholar
  8. 8.
    Oldham RK, Greco FA, Einhorn LH, et al.: Preliminary results of a randomized trial to evaluate the role of radiotherapy in the combined modality therapy of limited stage small cell lung cancer. Proc Amer Soc Clin Oncol 22:505, 1981.Google Scholar
  9. 9.
    Livingston RB: Treatment of small cell carcinoma: Evolution and future direction. Sem Oncol 5: 299–308, 1978.Google Scholar
  10. 10.
    Alberto P, Brunner KW, Martz G, et al: Treatment of bronchogenic carcinoma with simultaneous or sequential combination chemotherapy, including methotrexate, cyclophosphamide, procarbazine and vincristine. Cancer 38: 2208–2216, 1976.PubMedCrossRefGoogle Scholar
  11. 11.
    Edmonson JH, Lagakos SS, Selawry OS, et al.: Cyclophosphamide plus CCNU compared to cyclophosphamide alone in the treatment of small cell and adenocarcinoma of the lung. Cancer Treat Rep 60:925–932, 1976.PubMedGoogle Scholar
  12. 12.
    Lowenbraun S, Bertolucci A, Smalley RV, et al: The superiority of combination chemotherapy over single agent chemotherapy in small cell lung cancer. Cancer 44: 406 - 413, 1979.PubMedCrossRefGoogle Scholar
  13. 13.
    Aisner J, Whitacre M, Van Echo DA, et al: Alternating noncrossresistant combination chemotherapy for small cell carcinoma of the lung. Proc Am Assoc Cancer Res 21: 453, 1980.Google Scholar
  14. 14.
    Cohen MH, Creaven PI, Fosseick BE, et al: Intensive chemotherapy of small cell bronchogenic carcinoma. Cancer Treat Rep 349–354, 1979.Google Scholar
  15. 15.
    Israel L, DiPierre A, Choffel C: Immunochemotherapy in 34 cases of oat cell carcinoma of the lung with 19 complete responses. Cancer Treat Rep 61: 343–347, 1977.PubMedGoogle Scholar
  16. 16.
    Fox RM, Tattersall MHN, Woods RL: Radiation therapy as an adjuvant in small cell lung cancer treated by combination chemotherapy: A randomized study. Proc Amer Soc Clin Oncol 22: 502, 1981.Google Scholar
  17. 17.
    Hansen HH, Dombernowsky P, Hansen HS, Rorth M: Chemotherapy versus chemotherapy plus radiotherapy in regional small cell carcinoma of the lung — a randomized trial. Proc Am Assoc Cancer Res 20: 277, 1979.Google Scholar
  18. 18.
    Stevens E, Einhorn L, Rohn R: Treatment of limited small cell lung cancer. Proc Am Assoc Cancer Res 20: 435, 1979.Google Scholar
  19. 19.
    Cohen MH: Small cell lung cancer: restained optimism. Int J Radiat Oncol Biol Phys 6: 1119–1120, 1980.PubMedCrossRefGoogle Scholar
  20. 20.
    Salazar OM, Creech RH: The state of the art: Toward defining the role of radiation therapy in the management of small cell lung cancer. Int. J Radiat Oncol Biol Phys 6: 1103–1117, 1977.Google Scholar
  21. 21.
    Catane R, Lichter A, Lee J, et al: Small cell lung cancer. Analysis of treatment factors contributing to prolonged survival. Cancer 48: 1936–1943, 1981.PubMedCrossRefGoogle Scholar
  22. 22.
    Cohen MH, Lichter AS, Bunn PA, Glatstein ES, et al: Chemotherapy-radiation therapy (CT-RT) versus chemotherapy (CT) in limited small cell lung cancer (SCLC). Proc Am Assoc Cancer Res 21: 448, 1980.Google Scholar
  23. 23.
    Greco FA, Richardson RL, Sulman SF, et al: Therapy of oat cell carcinoma of the lung: complete remissions, acceptable complications and improved survival. Br Med J 2: 10–11, 1978.PubMedCrossRefGoogle Scholar
  24. 24.
    Perry CD, Eaton WL, Comis RL, et al: Simultaneous radiation therapy and chemotherapy in limited small cell cancer of the lung: a pilot study. Proc Amer Soc Clinical Oncol 22: 503, 1981.Google Scholar
  25. 25.
    Higgins CA, Shields TW, Keehn RJ: The solitary pulmonary nodule. Ten year follow-up of Veterans Administration — Armed Forces cooperative study. Arch Surg 110: 570–575, 1975.PubMedGoogle Scholar
  26. 26.
    Wright P, Shulman S, Davis S, et al: Unexpectedly favorable survival without intensive combination chemotherapy in patients with small cell lung cancer. Proc Amer Soc Clin Oncol 22: 493, 1981.Google Scholar
  27. 27.
    Martini N, Wittes R, Hilaris BS, et al: Oat cell carcinoma of the lung. Clin Bull 5: 144–148, 1975.PubMedGoogle Scholar
  28. 28.
    Shields TW: Status report of adjuvant cancer chemotherapy trials in the treatment of bronchial carcinoma. Cancer Chemother Rep 4: 119–124, 1973.Google Scholar
  29. 29.
    Karrer K: Adjuvant chemotherapy of post surgical minimal residual bronchial carcinomas. Recent Results Cancer Res 68: 246–259, 1979.Google Scholar
  30. 30.
    Bunn PA, Cohen MH, Ihde DC, et al.: Advances in small cell bronchogenic carcinoma. Cancer Treat Rep 61:333–342, 1977.PubMedGoogle Scholar
  31. 31.
    Ihde DC, Cohen MH, Bernaton AM, Matthews MJ, et al: Serial fiberoptic bronchoscopy during chemotherapy for small cell carcinoma of the lung. Early detection of patients at high risk for relapse. Chest 74: 531–536, 1978.PubMedCrossRefGoogle Scholar
  32. 32.
    Livingston RB, Moore TN, Helibrun L, et al: Small cell carcinoma of the lung: combined chemotherapy and radiation: a Southwest Oncology Group Study. Ann Intern Med 88: 194–199, 1978.PubMedGoogle Scholar
  33. 33.
    Mira JG, Livingston RB: Evaluation and radiotherapy implications of chest relapse patterns in small cell lung carcinoma treated with radiotherapy — chemotherapy: study of 34 cases and review of the literature. Cancer 46: 2557–2565, 1980.PubMedCrossRefGoogle Scholar
  34. 34.
    Feld R: Complications in the treatment of small cell carcinoma of the lung. Cancer Treat Rev 8: 5–26, 1981.PubMedCrossRefGoogle Scholar
  35. 35.
    Fox RM, Woods RL, Brodie GN, Tattersall MH: A randomized study: small cell anaplastic lung cancer treated by combination chemotherapy and adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 6: 1083–1085, 1980.PubMedCrossRefGoogle Scholar
  36. 36.
    Johnson RE, Brereton HD, Kent CH: Total therapy for small cell carcinoma of the lung. Ann Thorac Surg 25: 510–515, 1978.PubMedCrossRefGoogle Scholar
  37. 37.
    Holoye PY, Samuels ML, Lanzalotti VJ, et al: Combination chemotherapy and radiotherapy for small cell carcinoma. JAMA 237: 1221–1224, 1977.PubMedCrossRefGoogle Scholar
  38. 38.
    McMahon LA, Herman TS, Manning MR, Dean JC: Patterns of relapse in patients with small cell carcinoma of the lung treated with adriamycin-cyclophosphamide chemotherapy and radiation therapy. Cancer Treat Rep 63: 359–362, 1979.PubMedGoogle Scholar
  39. 39.
    Levitt M, Meikle A, Murray N, Weinerman B: Oat cell carcinoma of the lung. CNS metastasis in spite of prophylactic brain irradiation. Cancer Treat Rep 62: 131–133, 1978.PubMedGoogle Scholar
  40. 40.
    Abeloff MD, Ettinger DS, Baylin SB, Hazra T: Management of small cell carcinoma of the lung: Therapy, staging and biochemical markers. Cancer 38: 1394–1401, 1976.PubMedCrossRefGoogle Scholar
  41. 41.
    Gilby ED, Bondy PK, Morgan RL, et al: Combination chemotherapy for small cell carcinoma of the lung. Cancer 39: 1959–1960, 1977.PubMedCrossRefGoogle Scholar
  42. 42.
    Ginsberg SJ, Comis RL, Gottlieb AJ: Long-term survivorship in small cell anaplastic lung carcinoma. Cancer Treat Rep 63: 1347–1349, 1979.PubMedGoogle Scholar
  43. 43.
    Meyer JA, Comis RL, Ginsberg SJ, et al: Selective surgical resection in small cell carcinoma of the lung. J Thoracic Cardiovasc Surg 77: 243–248, 1979.Google Scholar
  44. 44.
    King G, Comis RL, Ginsberg S, et al: Combination multiple chemotherapy and radiotherapy in small cell carcinoma of the lung. Radiology 125: 529–530, 1977.PubMedGoogle Scholar
  45. 45.
    Gazdar A, Carney DN, Russell EK, et al.: Establishment of continuous, clonable cultures of small cell carcinoma of the lung which have amine precursor uptake and decarboxylation properties. Cancer Res 40: 3502–3507, 1980.PubMedGoogle Scholar

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© Martinus Nijhoff Publishers, Boston 1983

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  • Robert L. Comis

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