@PDBrownOnc @GirvigianMD Appreciate your support of NRG CC009. Amendment of NRG BN009 has just been approved by NCI. New randomization will be salvage SRS vs. salvage HA-WBRT. This is for patients with high brain met velocity after upfront SRS. Also permitting small cell and any # of prior SRS tx.

@PDBrownOnc With improved intracranial control and lower risk of radiation necrosis, HA-WBRT+memantine could provide better cognitive and neurologic symptom outcomes.  Alternatively, SRS may provide better cognitive protection.  Please support NRG CC009 so we can evaluate these questions.

@PDBrownOnc With compelling evidence supporting either HA-WBRT+memantine or SRS for small cell brain mets, we have reached equipoise in our field.  Our patients need our community to complete accrual to NRG CC009, SRS vs. HA-WBRT+memantine for small cell brain mets.

RT @PDBrownOnc: 70 SCLC w/337 brain mets treated SRS One-year CNS control rate: · 39% 1-2 Brain mets · 28% 3-5 Brain mets · 0% > 5 Brain me…

@PDBrownOnc Thanks for the plug re: NRG CC009. Similar to how your trial N0574 impacted the mgt of non-small cell brain metastases, NRG CC009 has the potential to impact mgt of small cell brain metastases, a paradigm becoming increasingly prevalent with the declining use of PCI.

Thank you for the opportunity to participate in this journal club. I need to jump off ... but thanks to the PREMER trial investigators and patients for this important trial. Emphasizes importance of supporting clinical trial enrollment. #RadOnc #JC

@Rad_Nation @fcounago @StephenVLiu @SorenBentzen With improvements in systemic therapies, it is difficult to expect OS improvement w/ CNS RT management. However, other endpts of neuro death (NRG BN009), neurocognitive function and patient-reported outcomes (CC003/CC009) remain important patient-centered outcomes. #RadOnc #JC

@HinaSaeedMD @Rad_Nation @fcounago @subatomicdoc @BK_radiation @HenningWillers @StephenVLiu It's a good question ... and something worth investigating as an exploratory analysis of NRG CC003 and Maverick. #RadOnc #JC

@fcounago @IanJPereira @Rad_Nation Thank you for your team's hard work in ensuring this vital quality assurance process is performed. It's a lot of voluntary effort ... but well worth it to prevent a false-negative result and benefit all of our patients. #RadOnc #JC

@BreastDocUK @Rad_Nation @fcounago @StephenVLiu I love this question. As an example, NRG CC001 showed prevention of not just tested neurocognitive decline, but also patient-reported neurologic symptoms (including patient-reported cognition). #RadOnc #JC

@HinaSaeedMD @IanJPereira @fcounago @Rad_Nation The use of neurocognitive testing in multi-institution clinical trials is quite complicated and requires an analysis of cultural and linguistic validation. This is the reason why trials using HVLT do not permit primary Spanish speakers. #RadOnc #JC

@IanJPereira @fcounago @Rad_Nation Please do not underestimate the importance of central review of treatment volumes/plans. Sparing a 4cc structure (hippocampal dentate gyrus) in a 1400 cc brain using IMRT has a learning curve. #RadOnc #JC

@StephenVLiu @IanJPereira @HenningWillers @HinaSaeedMD @SorenBentzen @Rad_Nation @fcounago @AmishiBajajMD @MonaArbabMD I think it's important to support the MAVERICK trial to better address this question. #RadOnc #JC

@azza64 @Rad_Nation @fcounago @StephenVLiu This is an important point. NRG CC003 will be a larger HA-PCI trial (n=392) with perhaps numerically more LS-SCLC pts to assess impact of HA on long-term survivorship. #RadOnc #JC

@fcounago @Rad_Nation Really good points. Would also add that NRG CC003 (U.S trial of PCI +/- HA for small cell lung cancer with n=392 pts) is slated to close early 2022. #RadOnc #JC

@IanJPereira @Rad_Nation @fcounago @SorenBentzen @StephenVLiu @HenningWillers @HinaSaeedMD @subatomicdoc @MonaArbabMD SCLC management is rapidly evolving, from the use of immunotherapy to questions regarding appropriate brain management. As an example, NRG CC009 is a trial of SRS vs. HA-WBRT for small cell lung cancer brain mets, just activated this past year. #RadOnc #JC

@BreastDocUK @Rad_Nation @fcounago @StephenVLiu #RadOnc #JC. Great question. Reliable change index is commonly used to determine clinically significant deterioration. Correlation with patient-reported outcomes is helpful.

Thank you to the #RadOnc #JC team for the kind invitation to join this journal club. Congrats to the PREMER trial team for this well-conducted trail.

Thank you to the organizers for the invitation to join this twitter jc. Congrats to PREMER team for the well-conducted HA-PCI trial.