The course of the
bronchial carcinoma and the therapeutic chances are influenced by the histologic
tumor type which determines the respective
biologic behavior. The most important clinical finding is the differentiation between small-cell and non-small-cell
bronchial carcinomas. Small-cell
bronchial carcinomas are characterized by a rapid duplication of the
tumor volume, a high rate of cell divisions and an early hematogenic and lymphogenic dissemination. They have therefore a good response to antiproliferative
chemotherapy. In almost 80% of patients
bronchial carcinomas with limited disease, a complete remission and a markedly prolonged median survival time can be achieved by combined
cytostatic chemotherapy, e.g. the
therapy regimens ACO I and ACO II. As yet, the problem of local and remote recurrences is not solved. The unfavorable prognosis of the primarily inoperable small-cell
bronchial carcinoma can be improved by
chemotherapy. On the other hand, the high remission rate is diminished by later incurable recurrences. A pretherapeutic differentiation of limited and extended disease is necessary. The necessity and conditions of an additional
radiotherapy have to be determined later on by means of prospectively randomized
therapy studies. As opposed to the small-cell
bronchial carcinoma, the non-small-cell
bronchial carcinoma shows a markedly lower response to
chemotherapy.
Adenocarcinomas are comparatively refractory to
chemotherapy, but
squamous cell carcinomas respond now a little better to
chemotherapy.