Small cell lung cancer is one of the most chemo and radiosensitive adult solid malignancies. The effects of treatment should be evaluated according to standardized rules to ensure reproducibility. Recent randomized clinical trials have shown that combined chemo and radiotherapy can improve survival. A 5-year survival rate of 20 per cent can be obtained for an initially limited disease. However, further improvement of results requires optimized drug combinations and multimodality approaches as well as a better integration of new biological concepts in therapeutic trials.