Combined-modality therapy for limited-stage small cell lung cancer

While the International Union Against Cancer system can be used in staging small cell lung cancer (SCLC) patients, the staging distinction of "extensive stage" versus "limited stage" is commonly used. This system defines limited stage as the ability to encompass all known disease within a "reasonable" radiation field. The standard management of limited-stage SCLC is concurrent platinum-based chemotherapy with thoracic radiotherapy (RT). Total RT doses range from 40 to 55 gy in most trials. A recently completed randomized trial showed an advantage to twice-daily accelerated hyperfractionated RT over standard RT alone. Most current clinical protocols for limited-stage SCLC use the "involved field" technique of thoracic RT, in which the RT target volume includes the known extent of primary tumor and lymph node involvement and one additional nodal station. Large fields including more extensive elective nodal irradiation are discouraged. Semin Oncol 28 (suppl 4):14-22.