# CREST: consolidation thoracic radiotherapy in extensive-stage small-cell lung cancer

Source: https://onco.cc/trials/crest-thoracic-rt/  
OnCo record `crest-thoracic-rt` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radiotherapy to the chest after chemotherapy for widespread small-cell lung cancer missed its main target but tripled two-year survival, which is why it is still offered.

## Summary

Most patients with extensive-stage small-cell lung cancer who respond to chemotherapy still have disease in the chest, and it is usually where they relapse. CREST randomised 495 such patients at 42 hospitals in the Netherlands, the United Kingdom, Norway and Belgium between February 2009 and December 2012 to thoracic radiotherapy, 30 Gy in ten fractions, or to none; all received prophylactic cranial irradiation. The mean interval from diagnosis to randomisation was 17 weeks.

The primary endpoint, one-year overall survival, was not met: 33 percent (95 percent confidence interval 27 to 39) with thoracic radiotherapy against 28 percent (22 to 34), hazard ratio 0.84 (0.69 to 1.01, p=0.066). In a secondary analysis, two-year overall survival was 13 percent against 3 percent (p=0.004), and progression was less likely with radiotherapy (hazard ratio 0.73, 0.61 to 0.87, p=0.001), with six-month progression-free survival 24 against 7 percent. No severe toxic effects were recorded; the commonest grade 3 or worse events were fatigue and breathlessness, in single figures.

CREST is the reason consolidation thoracic radiotherapy is offered to patients with residual thoracic disease after chemotherapy, and the reason it is offered as a discussion rather than as a rule: the trial predates the addition of atezolizumab and durvalumab to first-line chemotherapy, and whether the benefit survives alongside immunotherapy is being tested now.

## Fields

- Kind: Trial
- Status: mixed
- Last checked: 2026-09-25
- Also known as: CREST; Slotman thoracic radiotherapy trial
- Registry id: NTR1527
- Phase: 3
- Setting: Extensive-stage small-cell lung cancer responding to chemotherapy, performance status 0 to 2, all receiving prophylactic cranial irradiation: thoracic radiotherapy 30 Gy in ten fractions versus no thoracic radiotherapy, with overall survival at one year as the primary endpoint
- Sponsor: VU University Medical Center Amsterdam, with the Dutch, UK, Norwegian and Belgian groups
- Enrolled: 495
- Result: One-year overall survival 33 against 28 percent (hazard ratio 0.84, p=0.066, primary endpoint not met); two-year survival 13 against 3 percent (p=0.004).
- Outcomes: Overall survival at 1 year: Thoracic radiotherapy 30 Gy in 10 fractions 33% vs No thoracic radiotherapy 28%, HR 0.84; Overall survival at 2 years: Thoracic radiotherapy 30 Gy in 10 fractions 13% vs No thoracic radiotherapy 3%

## Sources

- CREST (Lancet 2015): https://doi.org/10.1016/S0140-6736(14)61085-0
- Netherlands Trial Register NTR1527: https://onderzoekmetmensen.nl/en/trial/21669

## Connected records

- cancers: [Extensive-stage small-cell lung cancer](https://onco.cc/cancers/extensive-stage-sclc/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/)
- technologies: [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- terms: [Consolidation therapy](https://onco.cc/terms/consolidation-therapy/), [Palliative](https://onco.cc/terms/palliative-treatment/)
- trials: [CASPIAN](https://onco.cc/trials/caspian/), [EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancer](https://onco.cc/trials/slotman-pci-es-sclc/), [IMpower133](https://onco.cc/trials/impower133/)

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