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Combined treatment with adriamycin, cyclophosphamide and vincristine (ACO) was used in 50 out-patients with histologically verified small-cell bronchial carcinoma. In 26 patients with locally and regionally limited metastases ("limited disease") radiotherapy (3000 rad focal dose) to mediastinum, hili and tumour opacity as well as prophylactic cranial irradiation (3000 rad focal dose) were performed after 3 cycles of chemotherapy. Complete clinical remission (without endoscopic control) was achieved in 32 out of 50 patients. Remissions in patients with bilateral pulmonary or extrathoracic metastases ("extensive disease", n = 24, 12 complete remissions) only led to limited asymptomatic prolongations of life (median survival time 10 months, median remission period 5 months) despite maintenance therapy. On the other hand patients with "limited disease" had considerable life prolongation (median survival 21 months, historical control value 3--4 months). Seven out of 26 patients in this group survived for 30 months after the onset of the disease, 6 out of 26 are now in their third year after starting therapy without signs of tumour recurrence. The results show that early recognition of patients with local and regional metastases has considerable prognostic value.

Fifty patients with inoperable bronchial carcinoma were treated with a combined schedule of adriamycin, cyclophosphamide and vincristine. In those cases with locally/regionally confined tumour spread this was followed - after three chemotherapy cycles - by radiotherapy to mediastinum, hilar region and tumour of 3000 rad focal dose. Remission was achieved in 25 of 27 patients with small-cell carcinoma: full clinical remission in 12, part remission in 13. Mean duration of the (in most instances still continuing) remission has so far been 4 + months. Mean survival time is, of course, not yet calculable. Only a few patients had to be admitted to hospital for short periods because of toxic reactions. Four full and 11 part remission (some still continuing) have so far been achieved in the group of larger-cell carcinoma (squamous cell, 4; large cells, 5; anaplastic, medium-large, undifferentiated or polymorph, 14).

Between 1973 and 1978 combined radiotherapy and chemotherapy were given to 22 patients with histologically proven Ewing's sarcoma. The combined chemotherapy consisted of cyclophosphamide, vincristin, adriamycin, as well as dacarbazine in some cases. The neoplasm was a localized one at the beginning of treatment in 14 of the 22. These patients received high-voltage radiotherapy to the primary focus at a focal dose between 42 and 55 Gray (4200-5500 rad), followed by chemotherapy. After 6--8 treatment cycles, adriamycin was replaced by methotrexate. Nine of the 14 patients survived without recurrence for 12 to over 59 months. Eight patients had extensive metastases at the beginning of treatment: they at first received only chemotherapy, followed by radiotherapy or operation, as indicated. Full clinical remission was achieved in five of them: in three this remission has now lasted for more than 18, 40 and 44 months, respectively. These results indicate that (1) additional chemotherapy improves the prognosis of localized Ewing's sarcoma, and (2) even in far-progressed cases the combination of chemotherapy and radiotherapy can achieve lasting remission, which may in fact be a true cure.