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[Current clinical aspects of changes in the lung parenchyma caused by the interaction of polychemotherapy and radiotherapy in the treatment of small cell bronchial cancer].

The use of radiotherapy in the treatment of bronchial carcinoma evokes changes of the healthy lung parenchyma which may lead to pneumonitis and fibrosis. At present more than 20 tumour chemotherapeutics with lung-toxical effect are known, which may induce a pneumonitis or a fibrosis. When two or more lung-toxically acting cytostatic drugs are combined, we have to take into consideration interactions with synergistic character on the healthy lung parenchyma. The combination of a lung-toxical cytostatic drug with the radiotherapy or the combination of a polychemotherapy with the radiation may cause pneumonitides and fibrosis with increased mortality rate. In our therapy programmes for the treatment of the small cell bronchial carcinoma the polychemotherapy of the tumours (I. cyclophosphamide, methotrexate, nitrosomethylurea, II. doxorubicin (adriamycin), dacarbacin, vincristine, III. cyclophosphamide, adriamycin, methotrexate) and the radiotherapy were simultaneously used. Hereby a pneumonitis was x-ray-diagnostically ascertained in more than 70% and a fibrosis in 30-80% of the patients treated. In our opinion these high rates of changes of the lung parenchyma have their cause in a complex process: interaction of the tumour chemotherapeutic drugs among one another; interaction of the tumour polychemotherapy with the radiotherapy (particularly in simultaneous application); the bronchial carcinoma is, depending upon anatomical localisation of the tumour and size a risk factor for an infection; the immunosuppressive situation of the patient increases the danger of an infection particularly in the area of the respiratory tract during the therapy. The course of a pneumonitis is decisively determined by a secondary infection.