During the past 10 years, 240 patients with Stage I11 small cell lung carcinoma (SCLC) were treated with one of five chemotherapy programs plus thoracic irradiation. In addition, prophylactic cranial irradiation was administered concurrently with thoracic irradiation to 194 patients receiving CAML-HC, VCAM, or MOCA. Seventy-two patients had disease confined to the chest (Stage IIIMO), 30 patients had disease in the chest plus ipsilateral supraclavicular nodal involvement (Stage IIIMO-+), and 138 patients had distant metastatic disease (Stage IIIMl); the median survivals were 15.2 months, 12.6 months, and 8.4 months, respectively. The overall complete response rate was 30% and the overall response rate (complete and partial) was 76%. The overall response rates by stage were 86% for Stage IIIMO, 90% for Stage IIIMOm+, and 67% for Stage IIIMl. Eight patients (3%) were alive and free of disease at 24 months. Due to continued disease relapse in this group (four of eight patients), long-term survivors should not be identified for a minimum of 3.5 years from the time of initial therapy. Prophylactic cranial irradiation (PCI) effectively reduced the incidence of central nervous system (CNS) relapse in patients with a complete response to therapy (44% relapse without PCI versus 13% relapse with PCI, P < 0.01). More effective chemotherapy is required for the successful treatment and improved long-term survival of patients with SCLC.