Traditionally, small cell lung cancer has been considered as a disease with early onset of distant metastases. Therefore, the role of locoregional therapy (radiotherapy or surgery) was thought to be very limited. This was supported by the first trials investigating the role of radiotherapy since there was no improvement of median survival. Recently, two meta-analyses changed this point of view: radiotherapy is essential to achieve long term survival. The possible biological explanation may be that uncontrolled distant metastases may cause the death of patients during the first months of their disease. The longer patients survive the more important local therapy becomes. Today, there is growing acceptance that adequate systemic and local therapy contributes to better treatment results of limited small cell lung cancer.