Some Recent Studies:

N Engl J Med 1992 Dec 3;327(23):1618-24 . A meta-analysis of thoracic radiotherapy for small-cell lung cancer..Pignon The relative risk of death in the combined-therapy group as compared with the chemotherapy group was 0.86 corresponding to a 14 percent reduction in the mortality rate. The benefit in terms of overall survival at three years was 5.4 percent. Indirect comparison of early with late radiotherapy and of sequential with non-sequential radiotherapy did not reveal any optimal time for treatment. There was a trend toward a larger reduction in mortality among younger patients: the relative risk of death in the combined-therapy as compared with the chemotherapy group ranged from 0.72 for patients less than 55 years old to 1.07 for patients over 70

Int J Radiat Oncol Biol Phys 1998 Mar 15;40(5):1039-47 Concurrent cisplatin, prolonged oral etoposide, and vincristine plus chest and brain irradiation for limited small cell lung cancer: a phase II study of the Southwest Oncology Group (SWOG-9229).Thomas .After a minimum follow-up duration of 17 months, the Kaplan-Meier median progression-free (PFS) and overall survival (OS) were 10 and 15 months, respectively. Two-year survival is 28%

J Clin Oncol 1992 Jun;10(6):890-5 Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis.Warde The risk difference method showed that radiation therapy improved 2-year survival by 5.4% and intrathoracic tumor control was improved by 25.3%. The risk difference for treatment-related deaths was 1.2% This meta-analysis
shows a small but significant improvement in survival and a major improvement in tumor control in the thorax in patients receiving thoracic radiation therapy. However, this is achieved at the cost of a small increase in treatment-related mortality.

J Clin Oncol 15:3030-3037 Randomized Study of Initial Versus Late Chest Irradiation Combined With Chemotherapy in Limited-Stage Small-Cell Lung Cancer Work. were randomly allocated to receive initial chest irradiation (ICI) or late chest irradiation (LCI) :The timing of radiotherapy had no significant effect on the 2-year overall survival rate (20% after ICI v 19% after LCI) or the 2-year in-field recurrence rate (72% after ICI v 68% after LCI). Median survival durations were 10.5 (ICI) and 12.0 (LCI) months.

J Clin Oncol 15:2840-2849 Randomized Trial of Alternating Versus Sequential Radiotherapy /Chemotherapy in Limited-Disease Patients With Small-Cell Lung Cancer: A European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group Study .Gregor, The overall median survival duration was 15 months, with 62% 1-year, 25% 2-year, and 14% 3-year survival rates. There was no significant difference between the arms. The median survival time was 14 months in A and 15 months in S.

Semin Oncol 1986 Sep;13(3 Suppl 3):24-30 Alternating chemotherapy and thoracic radiotherapy with concurrent cisplatin-etoposide for limited-stage small-cell carcinoma of the lung. Murray N, The median survival was 78 weeks and the 2-year survival rate was 32% with an average follow-up of 3 1/2 years.

J Clin Oncol 1998 Jul;16(7):2466-7 Thoracic radiation therapy added to chemotherapy for small-cell lung cancer: an update of Cancer and Leukemia Group B Study 8083. Perry. Three hundred ninety-nine patients with limited-stage small-cell lung cancer were randomized to receive thoracic radiation therapy that started on day 1 (arm I) or day 64 of chemotherapy treatment (arm II), or chemotherapy alone with cyclophosphamide, vincristine, and etoposide (later, doxorubicin). Thoracic radiation therapy consisted of 4,000 rad to the tumor and mediastinum with a 1,000-rad boost. All patients received prophylactic cranial radiation to a dose of 3,000 rad. Arm I patients had a median survival of 13.04 months, arm II patients 14.54 months, and arm III patients 13.58
months. Median time to clinical failure was 11 months in arm I, 11.21 months in arm II, and 8.7
months in arm III .With 10 years of follow-up, the two arms that included thoracic radiation therapy remain superior to chemotherapy alone.

N Engl J Med 1999 Aug 12;341(7):476-84 Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group.Auperin.We performed a meta-analysis to determine whether prophylactic cranial irradiation prolongs survival. The relative risk of death in the treatment group as compared with the control group was 0.84, which corresponds to a 5.4 percent increase in the rate of survival at three years (15.3 percent in the control group vs. 20.7 percent in the treatment group). Prophylactic cranial irradiation also increased the rate of disease-free survival (relative risk of recurrence or death, 0.75;  and decreased the cumulative incidence of brain metastasis (relative risk, 0.46. Prophylactic cranial irradiation improves both overall survival and disease-free survival among patients with small-cell lung cancer in complete remission.