Mediastinal irradiation in the treatment of small-cell lung cancer

Local control remains a major challenge in the treatment of limited small-cell lung cancer. In spite of the use of polychemotherapy, mediastinal irradiation is still necessary as regards local control and long-term survival. A high total dose and accelerated radiation improves local control, and survival time is increased by early mediastinal irradiation. Radiotherapy can be administered concomitantly with chemotherapy (etoposide and cisplatin) from the beginning. Optimal results seem to be obtained with hyperfractionated and accelerated irradiation, although there is a resulting increase in acute toxicity, primarily oesophageal. Alternating the radio- and chemotherapy schedule is often used as a treatment procedure, as it permits early mediastinal irradiation without a reduction in the dose of cytostatics. Dose intensity is in fact a significant prognostic factor in survival. It is probably through the evaluation of late effects that a definition can be made of the optimal schedule for combined mediastinal radiotherapy and chemotherapy in the treatment of limited small-cell lung cancer. (author)