Multimodality treatment with surgery in small-cell lung cancer.

The paper reviews the role of surgery in the local treatment of the primary tumour of small-cell bronchial carcinomas (SCLC) and the preliminary results of a multicentre cooperative prospective randomized trial with multimodality treatments of SCLC. This randomized cooperative trial was activated in 1979 comparing a new sequential intermittent polychemotherapy (sq CT) of three different drug combinations alternatingly given intermittently within one year after surgery, with a standard chemotherapy (CT) of one combination of four drugs given intermittently within three years after surgery. Observations on 25 patients at nine different cooperating surgical departments showed that sq CT was applicable and unexpected side-effects did not occur. Live table curves, calculated from 56 patients up to February 1986, indicate the improvement of the survival rate five years after surgery for the cure of 25 patients receiving sq CT after surgery in comparison with 31 patients receiving standard chemotherapy (36% : 22%). Following discussions of this and other results at the symposium "Adjuvant Therapy of Small-Cell Bronchial Carcinoma" at the 13th Congress of the International Society of Chemotherapy (ISC) 1983 in Vienna, a related new protocol was designed and activated by a further enlarged ISC-Study-Group in October 1984. This protocol for a two-armed randomized cooperative trial for patients operated for T1, 2N0M0SCLC is comparing a chemotherapy-combination 1 (CAV)--as also used in a trial of the North American Lung Cancer Study Group-0--with chemotherapy 2 (sq CT) as used in our forementioned previous study.