Editorial

Chemotherapy in non-small cell bronchial carcinoma Each year about 40 000 people in the United King-dom develop squamous or large cell carcinoma or adenocarcinoma of the lung (non-small cell lung cancer), and very few of them are cured by surgery or radiotherapy. About 60 % of patients have metas-tases at presentation and most of the others will develop local or systemic recurrence after surgery or radiotherapy. Many of those with advanced non-small cell lung cancer are elderly and in poor health and in such cases symptomatic treatment is all that can and should be offered. There remains, however, a substantial number of patients with advanced local disease or metastases who are reasonably young and active. Patients and clinicians are then often anxious that some form of treatment should be given and the question of whether there is anything to be gained by using chemotherapy then arises. In the last few years several drugs have shown antitumour activity when given as single agents and there are now many reports of improved survival in patients with respon-sive tumours. Is there a place for chemotherapy in selected patients? A critical examination of the reports of the results of chemotherapy shows that there are many prob-lems in study design, which have led to confusing and unreliable data. When tumours are growing slowly, as are some squamous cell lung cancers, early treatment will be associated with relatively long survival even if the " treatment " is totally inef-fective or indeed harmful. Tumours at an early stage ith their natural history are less widely metastatic and patients with these tumours will be more likely to have a good performance score, limited intrathoracic disease, and single rather than multiple metastases. All of these features have been shown to be indicators of a good prognosis. ' The problem is that not only will such patients live longer untreated than those with more advanced disease but they may be more likely to respond to chemotherapy. Response to chemotherapy may then be taken to be the reason why they survive longer than those who do not respond, rather than an associated or parallel feature. For this reason the comparison of surviva