Radiotherapy in Limited Small Cell Lung Cancer: Fractionation and Timing of Modalities.

The use of thoracic radiotherapy is important to survival in the treatment of limited disease small-cell lung cancer. How to administer that therapy is the subject of continuing clinical trials and ongoing clinical debates. This article focuses on the issues of fractionation of the radiotherapy and describes the rationale for accelerated treatment and hyperfractionated treatment in small cell lung cancer. Theoretical and clinical concepts and recent trials are discussed. Altered fractionation schemes appear to increase acute responding reactions, but are associated with improved local control. The issue of fractionation and central nervous system tolerance is reviewed. Since the cornerstone therapy for this systematic disease is multiagent chemotherapy, strategies for integration of thoracic radiotherapy and systemic chemotherapy are reviewed. The concepts of sequential, alternating, and concurrent therapy are discussed in the context of clinical trials. The issue of integration in the course of treatment is also discussed. Early versus delayed radiation treatment may have different meanings for clinicians and investigators dealing with this disease. All of these issues are covered for the modern cisplatin-etoposide era.