Although small-cell lung cancer (SCLC) makes up a smaller proportion of all lung cancers than it did 25 years ago, it remains a common cause of cancer mortality that requires more clinical and basic research than is currently underway. Trials of newer chemotherapy variations have failed to produce a regimen that is clearly superior to the two-drug combination of etoposide and cisplatin, which remains the standard of care for both limited and extensive stage SCLC. Paradoxically, advances in this systemic disease have come from radiotherapy innovations for limited SCLC, including addition of thoracic irradiation to systemic chemotherapy, more intense thoracic irradiation, early integration of thoracic irradiation with systemic chemotherapy, and prophylactic cranial irradiation.