Which patients with extensive stage small-cell lung cancer should and should not receive thoracic radiotherapy?

There is growing awareness of a possible role for consolidation radiotherapy to the chest in patients with extensive stage small-cell lung cancer (ES-SCLC), following completion of chemotherapy (1). In 1999, Jeremic et al. published the results of a study in which patients with ES-SCLC with a complete response after chemotherapy outside the thorax and either a complete or partial response inside the thorax were randomized between prophylactic cranial irradiation (PCI) and additional chemotherapy or PCI, thoracic radiotherapy (TRT) and additional chemotherapy. The authors found that the use of TRT significantly improved survival (2). Since then, a number of non-randomized (3) and retrospective studies (4,5) have also suggested that TRT could be beneficial in patients with ES-SCLC.