TREATMENT AND PROGNOSIS



Surgery is the therapy of choice for patients with non-small cell carcinoma who meet both physiological and anatomical criteria and have no evidence of extrathoracic spread. There is no ev­idence that postoperative radiation therapy or cnemotnerapy improves survival.

For those patients with small cell carcinoma or nonoperable non-small cell tumors, radiation therapy and chemotherapy are the only other mo­dalities. Chemotherapy in various combinations has improved the median survival of patients with small cell carcinoma limited to the thorax from the 3 months, untreated, to 16 to 17 months. For non-small cell carcinoma, chemotherapy has not significantly altered the outcome and because of the significant toxicity involved, it should not be used except in controlled experimental settings.

Radiation therapy is often used in small cell car­cinoma, both to treat the primary lung lesion and as prophylaxis against cerebral metastases. How­ever, there is no evidence that this prolongs sur­vival. Radiation therapy is not beneficial in non-small cell carcinoma and is limited to the pallia­tive management of pain, recurrent hemoptysis, effusions, or obstruction of airways or the superior vena cava.

The prognosis for patients with bronchogenic carcinoma is poor and has improved only slightly over the past few years despite the introduction of multiple new chemotherapeutic agents. Figure 24-3 depicts the expected outcome of 100 unse-lected patients with non-small cell carcinoma.