Cisplatin-etoposide based chemoradiation treatment for limited small cell lung cancer: the current situation

Although the role of thoracic radiotherapy in limited small cell lung cancer has been established by two meta-analyses, optimization of radiotherapy with chemotherapy requires a full understanding of the chemotherapeutics used and the factors involved in administration of thoracic radiotherapy. The Cisplatin-Etoposide (PE) combination has replaced the cyclophosphamide or doxorubicin as the combination of choice, but it isn't clear whether the addition of the other agents add to benefit or toxicity. New agents continue to be sought to improve systemic failure. This paper focuses on the radiotherapy variables: dose, volume, fractionation, temporal sequencing, and variety of methods of combining the modalities are discussed. Results of a variety of pilot studies using thoracic radiotherapy and the PE combination are discussed. A randomized trial of accelerated radiotherapy versus standard fractionation has been completed within the past year, but results are not yet available. Further trials are warranted to improve integration of modalities in order to increase survival and reduce local and systemic failure without increasing untoward effects.