Summary Whilst the incidence of small cell lung cancer (SCLC) has declined over the last twenty years, the prognosis of the disease remains poor. Major advances include improvements in radiotherapy techniques, the use of prophylactic cranial irradiation (PCI) for all stages of SCLC and the improved integration of chemotherapy and radiotherapy. It is unlikely that future advances in the treatment of SCLC will be related to standard chemotherapy. There is now a concerted effort within the research community to understand the mechanisms that underpin the molecular pathways in cancer. It is hoped that this understanding will lead to the development of targeted therapies that will not only prove efficacious but also less toxic than more conventional chemotherapy. In combination with newer techniques such as conformal radiotherapy and better imaging, it is hoped that the rates of long term survival will increase significantly in the future.