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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\u003EProphylactic cranial irradiation in the treatment of extensive-stage small cell lung cancer has proven value in reducing symptomatic brain metastases and in improving overall survival at 1 year. However, persistent intrathoracic disease occurs in 76% of such patients and intrathoracic disease progresses in almost 90% of this group. This article discusses data from the Chest Radiotherapy Extensive Stage Trial [CREST; NTR1527] that evaluated the use of thoracic radiotherapy in addition to PCI for treatment of ES-SCLC to prevent occurrence of thoracic disease and halt its progression.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiation Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERespiratory Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiation Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERespiratory Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EProphylactic cranial irradiation (PCI) in the treatment of extensive-stage small cell lung cancer (ES-SCLC) has proven value in reducing symptomatic brain metastases and in improving overall survival (OS) at 1 year [Slotman B et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2007]. However, persistent intrathoracic disease occurs in 76% of such patients and intrathoracic disease progresses in almost 90% of this group. Ben J. Slotman, MD, PhD, Vrije Universiteit Medical Center, Amsterdam, The Netherlands, presented data from the Chest Radiotherapy Extensive Stage Trial [CREST; NTR1527] that evaluated the use of thoracic radiotherapy (TRT) in addition to PCI for treatment of ES-SCLC to prevent occurrence of thoracic disease and halt its progression.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EEligibility requirements for CREST were patients aged \u2265 18 years with ES-SCLS disease, who had a World Health Organization (WHO) performance status score of 0 to 2 and had shown either a complete response (CR), a partial response (PR), or a \u201cgood response\u201d to 4 to 6 platinum-based chemotherapy treatments. Exclusions included any brain, leptomeningeal, or pleural metastases, and any previous brain radiotherapy or TRT. Patients were randomized and stratified by institute and presence or absence of intrathoracic disease, and then received PCI 2 to 7 weeks after chemotherapy and either TRT (10 fractions of 3 Gy) or no TRT. The primary end point of the study was OS, with secondary end points of progression-free survival (PFS), local control, failure pattern, and toxicity. The study was designed at 80% power to detect a hazard ratio of 0.76 for OS at 1 year (2-sided, with 5% significance). Accounting for a 5% dropout rate between randomization and start of treatment, 483 patients needed to be randomized. Accrual was successful, with 498 patients enrolled in 42 centers primarily in The Netherlands and the United Kingdom. The median patient age was 63 years, and 55% of participants were men and 45% were women. Over one-half of patients had a WHO performance status score of 1, whereas another one-third had WHO 0 and 10% had WHO 2 scores. In terms of their response to chemotherapy, just over 70% of patients had PR, one-fourth showed \u201cgood\u201d response, and just 5% had a CR. As seen in other studies, nearly 90% of such patients with ES-SCLC treated with chemotherapy had persistent intrathoracic disease.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe primary end point was not met for OS because the hazard ratio did not meet criteria for statistical significance (HR, 0.84; 95% CI, 0.69 to 1.01; \u003Cem\u003EP\u003C\/em\u003E = .066). However, in reviewing the OS curves, Dr Slotman said that the curves did begin to diverge in a statistically significant way at about 9 to 12 months in favor of TRT, and that the survival at 24 months was \u201chighly statistically significant\u201d (\u003Cem\u003EP\u003C\/em\u003E = .004). Intrathoracic progression data showed strong statistical significance, with 43.7% of patients progressing who had received TRT compared with 79.8% for the control group \u003Cem\u003E(P\u003C\/em\u003E \u0026lt; .001). Treatment was well tolerated, with all toxicities (cough, dysphagia, dyspnea, esophagitis, fatigue, insomnia, nausea\/vomiting, and headache) with no difference between the arms and restricted to grade 3 on the Common Terminology Criteria for Adverse Events v3 scale. Dr Slotman concluded that TRT administered in addition to PCI for patients with ES-SCLC improved OS and PFS, and that TRT should be offered in addition to PCI to patients with a response to initial chemotherapy.\u003C\/p\u003E\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\/14\/31\/9.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Overall Survival in CREST\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2002367522\u0022 data-figure-caption=\u0022Overall Survival in CREST\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\/14\/31\/9.2\/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\/14\/31\/9.2\/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\/14\/31\/9.2\/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\/11929\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EOverall Survival in CREST\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECREST, Chest Radiotherapy Extensive Stage Trial; TRT, thoracic radiotherapy.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from BJ Slotman, MD, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\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\/14\/31\/9.2.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?nzm2i1\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?nzm2i1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}