Thirty-three patients (pts) with small cell carcinoma (SCC) were treated with combined modality therapy consisting of radiation therapy (300 rad/15 fractions) and cyclophosphamide, adriamycin, methotrexate and leucovorin (CAML). Thirty of 33 pts showed an objective response to therapy with a median survival of 11.6 months for all patients. When survival was determined by stage, pts with disease limited to the chest had a better median survival (18.9 months) than pts with metastases to supraclavicular nodes (11.6 months, median) or wide-spread metastatic disease (8.0 months, median). Not withstanding the routine use of chest irradiation, lung recurrences developed in 7/33 pts and were more frequent than CNS relapse, 4/33. If survival is to be increased in SCC, more aggressive means of local tumor control need to be pursued.
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