Small-cell lung cancer (SCLC) is distinguished from non-small cell lung cancer (NSCLC) by its rapid tumor doubling time, high growth fraction, and early development of widespread metastases. Surgery alone offers the best chance for long-term survival in selected patients with stage I SCLC. Most patients with limited SCLC (stage I-IIIa) are treated with "comprehensive therapy" combined with chemotherapy, radiotherapy (thoracic radiotherapy and/or prophylactic cranial irradiation), and surgery. Although the efficacy of surgery in the control of local disease is well established, to date no report has shown better survival rates in patients who receive induction therapy when compared with patients receiving postoperative chemotherapy. However, studies of induction therapy include more patients with advanced-stage cancer than do studies of post-operative chemotherapy. Thus the final role of induction therapy followed by surgery must await the results of future prospective, randomized trials conducted by large cooperative study groups.