If you haven’t read this book by Swedish physician Hans Rosling, you should. In it he discusses how “human beings have a strong dramatic instinct toward binary thinking, a basic urge to divide things into two distinct groups, with nothing but an empty gap in between.” Because, hey, two groups is easy. And who reading this doesn’t love the simplicity of small cell lung cancer (SCLC) staging? You limited or you not. Well, apparently Dr. Rosling inspired someone with access to the CONVERT trial data. This intriguing unplanned secondary analysis looks specifically at the 17% (n=86) of enrollees with early-stage I-II (≤T2N1) disease. Perhaps unsurprisingly, their median survival overall was twice as long (50 months) as their stage III counterparts (25 months). More interesting is that this early-stage cohort numerically seemed to really benefit from twice-daily radiation with a median survival time of 72 months versus only 38 with daily radiation. TBL: If we allow ourselves to think beyond simply limited or extensive, early-stage SCLC treated with definitive chemoradiation can achieve outstanding outcomes that compare favorably to surgical series. | Salem, JAMA Oncol 2018


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