Radiochemotherapy in small-cell lung cancer

Thoracic radiotherapy and prophylactic cranial irradiation (PCI) in combination with chemotherapy is an established standard of treatment of limited-disease (LD) small-cell lung cancer (SCLC). Both types of radiotherapy increase 3-year survival by approximately 5%, as shown in the meta-analyses. There is some evidence that earlier commencement of thoracic radiotherapy for good performance status LD-SCLC patients results in better outcome. Total dose, fractionation type and irradiation volume are still matter of debate. The ongoing Phase III randomized trials aim to answer the question of total dose in LD-SCLC. For PCI, in LD-SCLC a standard dose of 25 Gy in ten fractions should remain a standard, as has recently been demonstrated. The PCI in extensive-disease SCLC improves survival at the expense of worsening of short-term health-related quality of life. There is evidence that consolidation thoracic radiotherapy may be of value in extensive-disease SCLC. The recently initiated prospective trials may answer this question.