Lung Cancer in Historical Perspective: Lessons From the Past, Implications of Present Experience, Challenges for the Future

Initial experience with a review of the 5882 patients with lung cancer admitted to the Toronto General Hospital since 1933 was encouraging as the salvage rate seemed to improve. By 1966, the overall salvage rate had increased from 3% to 13%. At that time, a 16% salvage rate was predicted, based on a respectability rate of 40% and a 5-year survival for resected cases of 40%. It seemed reasonable to anticipate continuing improvement as the value of treating early cases became more apparent. A recent review of 450 consecutive, unselected patients seen in primary referral showed that significant changes have not occurred in the past decade despite therapeutic innovations. These innovations have included radical combination therapy (preoperative radiotherapy) for biologically favourable, locally advanced disease (e.g., a 5-year survival of 31% in squamous carcinoma), limited resection in the compromised host (e.g., 5-year survival rate of 18% following sleeve resection), and combination chemotherapy with irradiation for small cell anaplastic carcinoma (e.g. approximately 20% free of active symptomatic disease for longer than 2 years). Unfortunately, the relatively small number of patients affected by these special maneuvers does not appreciably alter the overall survival rate. In the 450 patients, the respectability rate has been 43.5% with a 50year survival of 42.0%. In resected cases, producing a salvage rate of 18.3%. There was a 5-year survival of 2.4% in inoperable disease treated by other means (primarily radiotherapy). Salvage has, therefore, been achieved, in only one of five patients – scarcely an acceptable figure