To the Editor: In a letter in the May 9 issue of the Journal Donald C. Doll1 suggests that bone marrow examination can be omitted in the staging of patients with small-cell lung cancer and normal serum lactate dehydrogenase levels. The suggestion was based on data from 95 patients. To elucidate the consequences of this suggestion, we reviewed data from 942 patients with small-cell lung cancer who were consecutively included in prospective trials conducted in Copenhagen between June 1976 and May 1984. Pretreatment serum lactate dehydrogenase activity was determined and bilateral bone marrow biopsy and aspiration2 were performed in 872.
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