Is the progress in cancer treatment results adequate or are we confronted with a more or less worldwide stagnation

Abstract

Recent results of ongoing multicenter cooperative studies on patients treated with multimodality therapies of small-cell bronchial carcinoma are used as an example to demonstrate the definite progress of treatment results. This was possible only after a gradual development of aggressive intermittent long-term chemotherapy by different combinations of cytostatic drugs combined with various other kinds of therapy during the last three decades. The evaluation of results was only feasible after a step-by-step development of the international uniform pTNM staging system. This example is also useful to demonstrate the possible increased impact of these results, in spite of a very selected small number of patients, on the overall statistical survival with the assumption that the evaluable methods will be applied by a greater number of cooperative groups and in general practice. The life-table curves of pTNM-I-staged patients show a plateau of over 60% for the 4-year-survival rate, demonstrating much better results by comparison with non-surgical combined modality (radio- and chemotherapy) treatments. They are also much better than generally expected, which in turn demonstrates the great discrepancy in importance between the results from a scientific theoretical and a practical point of view. Only since the TNM staging system was developed has it been possible to distinguish the stages based on clinical diagnostic procedures, with a lower grade of certainty, from those with the precise pTNM staging based on the pathohistological findings.