{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzlnjp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzlnjp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/8\\\/23\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/8\\\/23\u0022}],\u0022ac\u0022:{\u0022spmdc;15\\\/8\\\/23\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;15\\\/8\\\/23\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe current evidence for the optimal delivery of radiation therapy in patients with small cell lung cancer is reviewed in this article. Hippocampal avoidance prophylactic cranial irradiation is being studied to reduce the associated neurocognitive deficits. Thoracic radiation therapy combined with prophylactic cranial irradiation was shown to improve overall survival and progression-free survival and reduce intrathoracic progression in the CREST trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECALGB 30610 trial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECONVERT trial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECREST trial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehippocampal avoidance PCI\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurocognitive toxicity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprophylactic cranial irradiation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eradiation therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esmall cell lung cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurocognitive toxicity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eoncology clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ESmall cell lung cancer (SCLC) is characterized by rapid tumor growth, initially high response rates to chemotherapy and radiation therapy (RT) followed by rapid treatment resistance, and about a 10% survival rate at 5 years. Different treatment approaches may be needed for different tumors, because experimental data have demonstrated a high level of cell heterogeneity, phenotypic variability, and a differential expression of epithelial-mesenchymal transition among different cell lines of SCLC, stated Rebecca B\u00fctof, MD, University Hospital, TU Dresden, Dresden, Germany.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe optimal time to initiate RT appears to be early (within 30 days) after the start of chemotherapy. In part, this may be due to the accelerated repopulation of tumor cells that typically occurs after any cytotoxic therapy, noted Prof B\u00fctof. Two meta-analyses showed a survival benefit with early vs late initiation of RT [Pijls-Johannesma M et al. \u003Cem\u003ECancer Treat Rev\u003C\/em\u003E. 2007; Fried DB et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E. 2004].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ERegarding the optimal dose of RT, the total gross tumor volume was shown to be an independent prognostic factor for overall survival (OS) [Reymen B et al. \u003Cem\u003EInt J Radiat Oncol Biol Phys\u003C\/em\u003E. 2013], thus volume-based dosing may be needed. Turrisi and colleagues showed in 1999 that twice-daily RT delivered over a shorter period of time (3 weeks, vs 5 weeks for once-daily RT) resulted in better median survival (23 months vs 19 months) and 5-year survival (26% vs 16%). Delivering RT in more (15) fractions was shown to improve 3-year OS vs conventional fractionation (39.4% vs 19.1%; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.004) [Socha J et al. \u003Cem\u003EJ BUON.\u003C\/em\u003E 2015]. However, the results of the CALGB 30610 [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00632853\u0026amp;atom=%2Fspmdc%2F15%2F8%2F23.atom\u0022\u003ENCT00632853\u003C\/a\u003E] and CONVERT [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00433563\u0026amp;atom=%2Fspmdc%2F15%2F8%2F23.atom\u0022\u003ENCT00433563\u003C\/a\u003E] trials are awaited to provide definitive answers for the optimal timing, dosing, and fractionation for RT in SCLC. Research is also underway to develop RT techniques that will spare normal tissue to ultimately reduce side effects related to RT.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EProphylactic Cranial Irradiation in SCLC\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EProphylactic cranial irradiation (PCI) became the standard of care to reduce the incidence of brain metastases (BMs) in patients with SCLC based on a meta-analysis showing that PCI prevented, rather than delayed, BMs [Aup\u00e9rin A et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 1999]. These findings were supported by the EORTC trial in patients with extensive-stage (ES) SCLC [Slotman B et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2007]. However, new data from a Japanese study in patients with ES-SCLC raise new questions about the use of PCI, because this study showed a higher incidence of BMs and no improvement in OS [Seto T et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E. 2014 (abstr 7503)].\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ENotably, the Japanese study used magnetic resonance imaging to define BMs, rather than symptomatic BMs as used previously. Yet, this trial was terminated early and the publication of the complete final results is needed to determine whether recommendations for the use of PCI should change, stated Cecile Le P\u00e9choux, MD, Institut Gustave Roussy, Villejuif, France. Further, differences in patient selection and the use of more second-line treatment in the Japanese study may contribute to differences in results between the studies.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ENeurocognitive toxicity is a concern with PCI, with reports of a higher risk of decline in self-reported cognitive functions at 6 and 12 months (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001) and declines in recall on the Hopkins Verbal Learning Test (HVLT) at 6 and 12 months (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.002) [Gondi V et al. \u003Cem\u003EInt J Radiat Oncol Biol Phys\u003C\/em\u003E. 2013]. A significant decline in memory at 1 year was also reported [Sun A et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E. 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EHippocampal avoidance (HA) when delivering whole brain RT was shown to preserve memory and quality of life in a study of this approach performed in 42 patients with lung or breast cancer who were compared with historical controls [Gondi V et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E. 2014]. The prospective, phase 3 HA-PCI trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01780675\u0026amp;atom=%2Fspmdc%2F15%2F8%2F23.atom\u0022\u003ENCT01780675\u003C\/a\u003E] is investigating the impact of this approach on the primary outcome of the total recall score of the HVLT at 4 months. A decline in this score of \u0026gt;\u20055 will be considered a failure, stated the lead investigator, Jose Belderbos, MD, PhD, The Netherlands Cancer Institute, Amsterdam, The Netherlands. RT will be delivered in 10 fractions up to 25 Gy, and magnetic resonance imaging will be performed at baseline, 4 months, and 1 year. Neurocognitive function, quality of life, incidence of BMs, and survival will also be assessed.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EThoracic Radiation Therapy for ES-SCLC\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ERecent data from the CREST trial [Slotman BJ et al. \u003Cem\u003ELancet\u003C\/em\u003E. 2015] provide more support for the use of thoracic radiation therapy (TRT) to treat residual intrathoracic disease in patients with ES-SCLC who have undergone chemotherapy and PCI. A retrospective study [Zhu H et al. \u003Cem\u003ECancer\u003C\/em\u003E. 2011] and an older single-center study by Jeremic and colleagues had shown improved OS with TRT.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EBen Slotman, MD, VU University Medical Center, Amsterdam, The Netherlands, explained that patients were randomized to PCI plus TRT or to PCI alone, with study treatment to begin between 2 and 7 weeks after chemotherapy ended. In the intention-to-treat analysis, there were 247 patients in the PCI plus TRT arm and 248 patients in the PCI arm. The median age was 63 years, 10.5% had a WHO performance score of 2, and 88% had persistent intrathoracic disease. The response to platinum-based chemotherapy was complete in 5%, partial in 70%, and good in 24%.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe difference in OS at 1 year did not reach statistical significance between the 2 groups (HR, 0.84; 95% CI, 0.69 to 1.01; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.066). However, at 2 years, OS was greater with PCI plus TRT vs PCI alone (13% vs 3%; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.004). Progression-free survival (PFS) was also significantly improved with PCI plus TRT (HR, 0.73; 95% CI, 0.61 to 0.87; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.001).\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EIn patients with residual intrathoracic disease vs those without, there was a significant improvement with TRT for OS (HR, 0.81; 95% CI, 0.66 to 1.00; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.05) and PFS (HR, 0.70; 95% CI, 0.70 to 0.85; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.002). Notably, there was a lower risk of disease progression within the thorax compared with other sites in the PCI plus TRT arm vs PCI alone (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/8\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Site of First Relapse in the CREST TrialReproduced with permission from B Slotman, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1792354181\u0022 data-figure-caption=\u0022Site of First Relapse in the CREST TrialReproduced with permission from B Slotman, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/8\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/8\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/8\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16315\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003ESite of First Relapse in the CREST Trial\u003C\/p\u003E\n               \u003Cp id=\u0022p-14\u0022\u003EReproduced with permission from B Slotman, MD.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-15\u0022\u003ERegarding the CREST trial not meeting its primary end point at 1 year, Prof Slotman stated it should have been a 2-year trial, because a meta-analysis by Pignon and colleagues showed that a survival benefit with TRT was not seen until 2 years. Furthermore, there continues to be about a 40% risk of disease progression in this population, and continued research is needed.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/8\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlnjp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlnjp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}