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.

A randomized trial of combined modality therapy employing combination chemotherapy (cyclophosphamide (CTX) and methotrexate (MTX), CTX, MTX and Vincristine (VCR) and CTX, VCR and high-dose MTX with citrovorum rescue) and radiation therapy was compared to cyclophosphamide and radiation therapy in 258 patients with pulmonary small cell carcinoma. Patients were also rendomized: 1) to determine the effects of prophylactic whole brain irradiation; and 2) to establish the effects of maintenance chemotherapy. Survival, frequency of response and site of relapse were different in patients with limited disease (LD) (disease confined to lung, mediastinum and supraclavicular lymph nodes) when compared with disease spread beyond these sites (extensive disease) (ED). No survival advantage was seen in LD when combination chemotherapy was employed, although the frequency of complete remission was greater with three drugs than with one or two drugs (40% vs. 32%). In ED frequency of response was greater for three drugs than for one and two drugs (60% vs. 40%), but there was no survival advantage. The median survival time for complete responders was similar for limited or extensive disease (12.1 months), but 23.8% were alive at 24 months with LD compared to none with ED. Maintenance chemotherapy significantly prolonged survival by 16.8 months with 33% alive at 24 months compared to 9% who were unmaintained. Prophylactic while brain irradiation prevented brain metastases with only 4% developing this complication as compared to 18% of control subjects, but did not influence survival.

We studied the thyroid function of 64 patients with Hodgkin's disease who received mantle irradiation during the period 1966 to 1976. More than two thirds (44 of 64) had some thyroid dysfunction. Twenty had mild dysfunction manifested by an abnormal thyroid-stimulating hormone response to thyrotropin-releasing hormone. Twenty had what could be termed compensated hypothyroidism while four were overtly hypothyroid. The severity of dysfunction was not related to age, sex, or chemotherapy. We found, however, that decreased thyroid function was inversely proportional to the length of time between a diagnostic lymphangiogram and the radiation therapy. These results are consistent with the hypothesis that the iodine load of the lymphangiogram renders the thyroid gland more radiosensitive. Thyroxine suppression of the thyroid gland during the period from the lymphangiogram through the termination of radiation therapy is suggested as a means of avoiding thyroid injury.