Multiple studies have confirmed the value of radiation therapy in limited-stage small-cell lung cancer. The appropriate dose of radiation and the optimal fractionation scheme, however, remain controversial. This article will examine the history of radiation therapy in the management of small-cell lung cancer. It will review the rationale for the various approaches to radiation dose intensification, and review the results of important trials investigating the issue of radiation dose in the management of this disease. Survival outcomes and toxicity of various approaches to radiation dose intensification, including dose escalation and hyperfractionation, will be assessed. The implications of advancements in technology will be examined, and the optimal design of future trials will be discussed.