Combined chemoradiotherapy in small cell lung cancer

Limited-stage small cell lung cancer remains a disease for which cure has been an elusive goal. Concurrent radiotherapy with EP chemotherapy is the current standard of care, and can provide cure in 15% to 25% of patients. Early concurrent chemoradiotherapy imparts a small, but real, 5% long-term survival advantage compared with sequential radiotherapy at the expense of increased toxicity. Hyperfractionated radiotherapy may provide a small additional incremental benefit; however, its implementation on a wide-scale basis has yet to occur. Increases in the total dose of radiotherapy that is delivered are possible; however, survival benefit has not been proven. Reduced radiotherapy volumes may provide a means to improve long-term survival rates by allowing higher doses of radiotherapy to a more select field without compromising efficacy. Despite the introduction of multiple new chemotherapeutic agents, EP-based regimens remain the standard chemoradiotherapy treatment protocols for limited-stage small cell lung cancer. Newer agents are needed desperately and are under investigation. Attempts to improve results through the use of induction, consolidation, maintenance, and high-dose chemotherapy schedchemoradiotherapy ules have not proved fruitful. Novel agents offer promise, but they remain investigational at this time.