A no-brainer addition to PCI.

It has been almost 3 years since the Slotman trial established an overall survival advantage at 2 years with thoracic radiation (3 Gy x 10) in addition to standard chemo and prophylactic cranial irradiation (PCI) for extensive-stage small cell lung cancer (ES-SCLC) patients without brain mets. Great, let’s do it! Actually, not so fast--improving an outcome isn’t a binary question. At some point we have to decide just how many people we’re willing to treat in order to prolong one life. The Slotman number needed to treat: 11. So is this worth it? Glad you asked. A shrewd Red Journal pub aims to quantify the overall healthcare cost of achieving each prolonged life in the Slotman trial. Now, we could argue forever (and probably will) about how much a quality-adjusted life year (QALY) is worth in dollar signs...but it turns out we don’t have to here. Remarkably, thoracic radiation dominated. And by that we mean a very precise mathematical term for an intervention that both decreases overall healthcare costs and increases QALY. Or in non-economic layman’s terms: the addition of thoracic radiation for ES-SCLC with a good response to chemo is a no-brainer.