Commentary on 'Small-Cell Lung Cancer at the Millennium: Radiotherapy Innovations'

Dr. Murray has compiled an excellent review of the current literature, and his interpretations of the available literature are insightful. However, we would like to add to Dr. Murray’s interpretation of the literature in two areas: first, the optimization of the timing of thoracic radiotherapy (TRT) and second, the interpretation of the two recently published trials of twice-daily TRT (TD-TRT) vs. once-daily TRT (OD-TRT) in limited-stage small-cell lung cancer (LSCLC). First, the optimization of the timing of thoracic radiotherapy in combination with multi-agent chemotherapy has been the subject of much investigation. Dr. Murray hypothesizes that the randomized studies that have failed to show a survival advantage for the use of early TRT (cycle 1 or 2) vs. late TRT (after cycle 2) have generally displayed overall lower survival rates, compared to studies displaying the opposite finding. He suggests that early TRT (compared to late TRT) may only show a detectable advantage for patients with favorable LSCLC and a low likelihood of gross metastatic disease. His hypothesis is intriguing, and may be valid, but caution should be exercised when comparing subpopulations