Improved chemotherapy for small-cell undifferentiated lung cancer

GOECP/SEOR radiotherapy guidelines for small-cell lung cancer

Small cell lung cancer (SCLC) accounts for approximately 20% of all lung cancers. The main treatment is chemotherapy (Ch). However, the addition of radiotherapy significantly improves overall survival (OS) in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch. Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non-metastatic patients. The 5-year OS rate in patients with limited-stage disease (non-metastatic) is slightly higher than 30%, but less than 5% in patients with extensive-stage disease (metastatic). The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis, planning, and treatment of SCLC. These guidelines emphasise treatment fields, radiation techniques, fractionation, concomitant treatment, and the optimal timing of Ch and radiotherapy. Finally, we discuss the main indications for reirradiation in local recurrence.

Basic treatment considerations: chemotherapy

Lung cancer represents a major global health problem, with more than a million deaths reported each year. Because there are no effective screening tools to date, diagnosis of the disease at an advanced stage is a common feature. Over the past 20 years, elegant strides have been made in the treatment of patients with advanced NSCLC. Several novel chemotherapy agents that are efficacious and possess favorable toxicity profiles have been developed recently. In addition to evaluating novel combinations, alternative schedules to improve toxicity profiles are subjects of clinical trials. Much work needs to be done, however, to improve the outcome for patients with lung cancer. Chemotherapy extends life and improves quality of life for patients with stage IIIB/IV NSCLC. Combined modality therapy with radiation and chemotherapy improves the outcome for patients with locally advanced NSCLC and is associated with a curative potential. Molecularly targeted therapies are under rigorous evaluation, although the initial results have been disappointing. In the upcoming years, we will learn effective means to incorporate molecularly targeted therapies to existing treatment paradigms in lung cancer.

Treatment of metastatic sweat gland carcinoma by a four drug combination chemotherapy: response in two cases

Two patients with metastatic sweat gland carcinoma were treated with a combination chemotherapy consisting of adriamycin, cyclophosphamide, vincristine and bleomycin. In one patient, a complete remission of two years' duration, and in the other a partial remission (4 + months) were achieved. A review of the literature about chemotherapy in metastatic sweat gland carcinoma is given.

The use of levamisole as an adjunct to chemotherapy and radiotherapy in the treatment of small cell carcinoma of the lung

To test the efficacy of immunotherapy in the treatment of small cell carcinoma of the lung, patients were allocated at random, in a double-blind controlled trial, to treatment with either levamisole or placebo as an adjunct to chemotherapy with multiple drugs (cyclophosphamide, vincristine, methotrexate and adriamycin) and to radiotherapy. We report here the results of a pilot study of 13 patients. The median survival period of the patients who were given levamisole was 25 weeks. This was significantly shorter (P less than 0.05) than that of the patients who were given placebo (46 weeks).

Combined chemotherapy and radiotherapy for the treatment of small cell carcinoma of the lung

Twenty-nine (88%) of 33 patients who were treated with multiple drug chemotherapy and radiotherapy for small cell carcinoma of the lung showed significant improvement in their clinical condition and quality of life. Treatment was well tolerated and toxicity was acceptable.