Based upon the analysis of lung cancer patients without any anticancer therapy, the present state and problems of the treatment for pulmonary carcinoma were studied. Clinical materials included the cases not only of our department but also from many other hospitals, with collection done by ourselves.
From the results of analysis of the cases without treatment the survival was in proportion to the grade of clinical stage and performance status. With regard to the histological type the patients with epidermoid cancer survived for the longest period and the cases with small cell cancer the shortest. As for adenocarcinoma two groups can be seen, one was long survival and the other was rapid progression. The survival period is related to the grade of malignancy of adenocarcinoma. The median survival time of the no treatment group was less than six months. In the progression curve in stage to death, the slopes from stage I to III were gentle and those from III to death were steep. This can be expressed as the cascade of lung cancer progression.
The five year survival rate of surgically resected cases was about 20%. The frequency of metastasis was 62% in the patients who underwent surgical resection for primary tumor and died within one month after the operation. This suggests that some adjuvant therapy should be added to the surgery. In our surgical department surgery and adjuvant chemotherapy for the patients with relative curative resection had positive effects on survival, but this was a historical study. The evaluation for adjuvant chemotherapy is not established because some randomized clinical trials had positive results while others had negative results. Recently surgery with adjuvant immunotherapy is being studied by a randomized controlled trial.
Comparison between no treatment and non-surgical treatment groups was carried out using same background factors. Even if the patients were above seventy years old, in poor performance status and in advanced stage, the survival period of the non-surgical treatment group was lengthened. Although the survival period of the no treatment group with small cell cancer was shorter than the group with non-small cell cancer, when non-surgical treatment was given to small cell cancer patients, they survived as long as non-small cell cancer patients. Concerning small cell cancer the responders to therapy survived longer than non-responders. Recently there are many reports showing that chemotherapy of small cell cancer produces good results.
There are many factors contributing to death of patients, for example pleural carcinomatosis, stenosis of large airway and pulmonary infection. It has become possible to manage malignant pleural effusion by tube drainage with intracavitary injection of immunoactivating drugs. The Nd-YAG Laser surgery is being tried for the improvement of large airway stenosis by intracanal tumor. The early detection and treatment for the respiratory tract infection of the cancer patients contribute to the survival.
In conclusion, at present lung cancer treatment should be based on the concept of multidiciplinary therapy using combinations of the treatments mentioned above.
