As of January, 1976, 257 patients with lung cancer who were entered into one of the four surgical adjuvant chemotherapy lung trials prior to January, 1966, had survived 10 years. One hundred twenty-five of these 257 patients had been in the program for 15 years, and 69 patients had survived. One hundred thirty three lobectomies, 120 pneumonectomies, and four lesser resections were the procedure performed. The cell type was squamous cell in 185 patients, adenocarcinoma in 24, other cell types in 47, and unknown in one. Lymph node metastases at the time of resection were absent in 185 of the patients, present in either the lobar or hilar nodes in 59, and present in the mediastinal nodes in 11, the status was unknown in two. Ninety-seven patients have died since the tenth year anniversary. The major causes of death were cardiovascular and pulmonary diseases and second primary carcinomas. The latter were the cause of death in 25 patients. Of the 257 patients, 51 (19.8%) had a second primary tumor. In 25 patients a second lung tumor was discovered - in seven patients prior to the eleventh postoperative year and in 18 patients after the tenth year. Six of these patients had a new primary in another organ system as well. Nine patients underwent definitive surgical treatment of the new lung lesion. In 26 additional patients, a second or even a third new primary was discovered in another organ system. Over one half of the patients with these tumors could be treated definitively. Because of the high risk of the occurrence of a second primary tumor in the long-term survivors, frequent and life-long observation is indicated.