【正文】 requency and severity of the longterm toxicities induced by PCI29． PCI is now routinely remended for those patients who achieved CR to chemotherapy30． Moreover, as more effective chemotherapy and bined chemoradiation improves the overall oute and longterm survival of SCLC patients, the potential risk of chronic NT will be greater and the quality of life(QOL)bees a more important consideration among the longterm ． Given that PCI has bee a standard treatment for LDSCLC patients who have achieved CR, it is no longer ethical to conduct randomized controlled trials including an arm with no PCI32． There is general agreement that patients with smallcell lung cancer(SCLC)and good performance status should be offered chemotherapy and when indicated, radiotherapy, aimed at prolonging survival and achieving a proportion of ． The use of carboplatin avoids the nephrotoxicity, neurotoxicity, and ototoxicity associated with cisplatin, and carboplatin can be substituted for cisplatin without survival detriment or the fluid loading needed with cisplatin, which can be problematic in lung cancer patients34． Phase II studies of ICE and ICEV, followed by thoracic and prophylactic cranial radiotherapy when clinically indicated, in patients with good performance status and limitedstage(LS)or extensivestage(ES)SCLC, reported plete response rates in excess of 50% and 2year survival rates ranging from 24% to 33% for LS and 14% to 23% for ES35． However, because these instruments had not been pared previously in a randomized fashion, this trial represented an opportunity to pare them in terms of pliance and ability to detect differences between regimens to guide the selection of QL instruments in future ． to pare these two chemotherapy policies in terms of adverse effects of treatment and QL37． This randomized trial has shown that a regimen of ICEV administered every 4 weeks significantly prolongs survival pared with standard, mainly nonplatinumbased chemotherapy administered every 3 weeks in the treatment of patients with SCLC and good performance status38． Perhaps counterintuitively39． The benefit seen in the current trial with a platinumbased regimen is echoed by two retrospective reviews, a metaanalysis based on published data, and one more recent trial40． A review of SCLC patients treated at the US National Cancer Institute suggested a modest survival benefit for PE in LS patients41． Treatment for patients with SCLC and a good PS might be improved by adding one or more drugs to platinum/etoposide, dose intensification, the use of concurrent chemoradiotherapy, or the use of new drugs are a number of ways of increasing the total dose and the doseintensity of chemotherapy: increasing the number of cycles, increasing the dose per cycle, decreasing the interval between cycles, or binations of metaanalysis of the published literature28 suggested that all of these strategies are relevant for improving survival, although not all individual trials show this pattern there are proven survival benefits in adding radiotherapy to chemotherapy for LS SCLC patients,30,31 the optimum timing of radiotherapy is unclear recent metaanalysis of fully published trials32 indicated a benefit for early thoracic radiotherapy, particularly in conjunction with PE chemotherapy and with hyperfractionated radiotherapy Japanese trial35 paring concurrent chemoradiotherapy(PE with 45 Gy administered in twicedaily fractions starting with cycle 1 every 4 weeks)and sequential treatment 4(cycles of PE administered every 3 weeks with the same radiotherapy administered after cycle 4)showed a much improved median survival with concurrent treatment( v months)although with only 231 patients, this did not translate into a statistically significant difference emergence of newer cytotoxic drugs may also offer opportunities to improve the outlook of patients with SCLC all the above strategies are worth pursuing, the future probably lies with biologically targeted agents。SCLC exhibits numerous molecular abnormalities, including neuropeptide, gastrinreleasing peptide, CD117, and vascular endothelial growth factor expression, which may be exploitable