The role of radiotherapy in the management of small cell lung cancer (SCLC).

In the past decade the management of small cell lung cancer (SCLC) has undergone substantial changes with respect to surgery, chemo- und radiotherapy. Due to combined chemotherapy regimens survival rates increased and the role of radiotherapy has been reevaluated. Despite this, the majority of patients treated with chemotherapy alone failed at the primary site. Several randomized studies have shown that irradiation (35 to 40 Gy) following chemotherapy has increased locoregional control rates. There is no uniform opinion about the treatment volume, fractionation schedule or optimal dose of radiotherapy. Recent reports have demonstrated better local control rates with radiation doses in excess of 45 Gy. Prophylactic cranial irradiation with 20 to 40 Gy is widely used in patients with SCLC and generally accepted in patients with complete remission after chemotherapy. Randomized studies have proven that prophylactic cranial irradiation reduces central nervous system relapses, however, no author has reported so far a significant improvement in survival.