Consolidative radiation therapy for extensive-stage small cell lung cancer

Despite the use of systemic therapy and prophylactic cranial irradiation (PCI), outcomes for patients with extensive-stage small cell lung cancer (ES-SCLC) remain poor. Consolidative radiation therapy (RT) to the chest may improve outcomes by improving local control. In a recently completed multi-institutional phase III clinical trial, investigators randomized patients with ES-SCLC and response to chemotherapy to PCI with or without consolidative RT. Two-year overall survival (OS) and 6-month progression-free survival (PFS) were improved with the use of consolidative RT; however, the prognosis for ES-SCLC in the experimental arm was still poor and there was no statistically significantly difference in 1-year OS, the trial's primary endpoint. In this editorial, the results of this trial are discussed and the methods are compared to those used in other trials of consolidative RT in ES-SCLC. More research is needed to identify the optimal RT dose and fractionation and to clarify the role of consolidative RT in ES-SCLC.