Survival, adverse reactions and quality of life during combination chemotherapy compared with selective palliative treatment for small-cell lung cancer. Report to the Medical Research Council by its Lung Cancer Working Party.

Two policies of treatment for small-cell lung cancer, both of which have their advocates in the United Kingdom, have been compared in a randomised multicentre study. Of a total of 151 patients, 76 were allocated to immediate combination chemotherapy and radiotherapy, and 75 to selective treatment in which treatment was not necessarily started immediately, but chemotherapy and, or, radiotherapy was given as and when required to control symptoms. With the policy of immediate compared with selective treatment, survival was longer (P less than 0.001, log-rank test), metastases were better controlled, and the quality of life as assessed intermittently by the clinicians was better, but there were more treatment-related deaths, adverse reactions were more common, reactions other than alopecia being reported in 80% compared with 33% (P less than 0.001) and the quality of life as reported daily by the patients using a diary card was worse.