Small cell carcinoma of the lung: Staging, paraneoplastic syndromes, treatment, and survival

Thirty-seven patients with small cell carcinoma of the lung were staged prior to therapy. The incidence of "extensive" or extrathoracic disease was 84%. Fourteen percent had CNS metastases. Bone marrow metastases were present in 47%. Laboratory and/or clinical evidence for a paraneoplastic syndrome was present in 26%. The majority of patients were treated with a three-drug combination plus radiation therapy of the lung primary. Eighty-eight percent of the patients treated with cyclophosphamide and vincristine had an objective response. Methotrexate was felt to be superior to Procarbazine as the third drug because fewer instances of progressive disease were noted during that portion of the chemotherapy cycle in which the third drug was used. Of 26 patients treated with both chemotherapy and radiation therapy, 55% had a complete response. The CNS was one of the sites of relapse in 21% of patients, and was involved by tumor in 45% of patients autopsied. The median survival in patients treated with both chemotherapy and radiation therapy was 9.5 months, and was significantly better (p < 0.005) than the median survival of a group of 45 patients from our tumor registry.