Not All Nails Need a Hammer

In this case of metastatic small cell lung cancer, we should be first reminded that this is a noncurable scenario (1). As nicely shown in the summary table contained in the Radiation Therapy Oncology Group (RTOG) 0937 publication, the best reported 5-year survival was less than 10% in the Jeremic study from 1999 (2, 3). In fact, neither RTOG 0937 nor the CREST trial was able to meet their primary endpoints (4). The CREST trial has a much ballyhooed 7% survival benefit at 2 years. Equally important, RTOG 0937 showed a doubling of grade 3 toxicity when adding thoracic radiation therapy to prophylactic cranial irradiation (PCI).

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