The Role of Radiotherapy in Small Cell Lung Cancer: a Revisit

Small cell lung cancer is staged as either limited (potentially curable) or extensive (incurable), based on the extent of disease in the chest. Limited stage disease is treated with concurrent chemotherapy and thoracic radiotherapy followed by prophylactic cranial irradiation (PCI). The conventional approach to extensive disease is chemotherapy only, with radiotherapy reserved for site-specific palliation. Recent reports suggest increasing applications for radiotherapy. The administration of PCI to extensive stage patients demonstrating response to chemotherapy is now recommended due to local control and overall survival benefits. Likewise, the role of consolidation chest radiotherapy after chemotherapy for advanced disease patients has seen a resurgence of interest in light of a recent publication suggesting improved local benefits which may influence survival. Recent technical advances in radiotherapy such as stereotactic body treatment and intensity-modulated therapy may also provide new indications for radiation, to enhance delivery and minimize toxicities.