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Incorporation of radiotherapy fractionation in the combined-modality treatment of limited small-cell lung cancer.

Although systemic failure continues to plague patients receiving combined-modality treatment for limited small-cell lung cancer (SCLC), improvements in chemotherapy, including use of cisplatin/etoposide-based regimens, and radiotherapy have produced increases in median, 2-year, and 5-year survival over the last decade. Employing more conservative volumes of radiotherapy in more aggressive ways, today about 50% of SCLC patients will survive 2 years and 30%, 5 years. Moreover, integrating radiotherapy with chemotherapy early in the course of treatment can potentially eliminate resistant clones. The various factors in radiotherapy, including dose, volume, fractionation, and timing, therefore deserve scrutiny in the reporting and design of clinical trials.