Patients with limited-stage small-cell carcinoma of the lung are treated wi
th combined-modality therapy with the intent to cure. Standard therapy cons
ists of platinum-based combination chemotherapy, thoracic irradiation, and
for responders, prophylactic cranial irradiation. Despite this aggressive a
pproach, too few patients achieve 5-year survival. In the past several year
s, new chemo-therapeutic agents, including the taxanes and the topoisomeras
e I inhibitors, have demonstrated substantial activity against small-cell c
arcinoma. These agents are now being incorporated hto clinical trials for p
atients with limited-stage disease. The best combination of these agents wi
th platinum-base regimens is yet to be determined, and data supporting incr
eased survival are awaited. Other studies are exploring thoracic radiation
issues. Questions remain regarding optimal timing, dose, volume, and fracti
onation schemes. The most effective combination of thoracic irradiation and
the newer chemotherapy agents also remains to be determined. The current a
pproach to limited-stage small-cell carcinoma is reviewed, ongoing trials a
re described, and future directions are explored.