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Topic Contents
- General Information About Small Cell Lung Cancer
- Cellular Classification of Small Cell Lung Cancer
- Stage Information for Small Cell Lung Cancer
- Treatment Option Overview for Small Cell Lung Cancer
- Limited-Stage Small Cell Lung Cancer Treatment
- Extensive-Stage Small Cell Lung Cancer Treatment
- Recurrent Small Cell Lung Cancer Treatment
- Changes to This Summary (02 / 19 / 2013)
- About This PDQ Summary
- Get More Information From NCI
Small Cell Lung Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Small Cell Lung Cancer Treatment
General Information About Small Cell Lung Cancer
Small cell lung cancer (SCLC) accounts for approximately 15% of bronchogenic carcinomas.
At the time of diagnosis, approximately 30% of patients with SCLC will have tumors confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes. These patients are designated as having limited-stage disease (LD).[1] Patients with tumors that have spread beyond the supraclavicular areas are said to have extensive-stage disease (ED).
SCLC is more responsive to chemotherapy and radiation therapy than other cell types of lung cancer; however, a cure is difficult to achieve because SCLC has a greater tendency to be widely disseminated by the time of diagnosis.
Incidence and Mortality
The overall incidence and mortality rates of SCLC in the United States have decreased during the past few decades.[2]
Estimated new cases and deaths from lung cancer (SCLC and non-small cell lung cancer [NSCLC] combined) in the United States in 2013:[3]
- New cases: 228,190.
- Deaths: 159,480.
Clinical Features
Lung cancer may present with symptoms or be found incidentally on chest imaging. Symptoms and signs may result from the location of the primary local invasion or compression of adjacent thoracic structures, distant metastases, or paraneoplastic phenomena. The most common symptoms at presentation are worsening cough, shortness of breath, and dyspnea. Other presenting symptoms include the following:
- Chest pain.
- Hoarseness.
- Malaise.
- Anorexia.
- Weight loss.
- Hemoptysis.
Symptoms may result from local invasion or compression of adjacent thoracic structures, such as compression involving the esophagus causing dysphagia, compression involving the laryngeal nerves causing hoarseness, or compression involving the superior vena cava causing facial edema and distension of the superficial veins of the head and neck. Symptoms from distant metastases may also be present and include neurological defect or personality change from brain metastases or pain from bone metastases.
Infrequently, patients with SCLC may present with symptoms and signs of one of the following paraneoplastic syndromes:
- Inappropriate antidiuretic hormone secretion.
- Cushing syndrome from secretion of adrenocorticotropic hormone.
- Paraneoplastic cerebellar degeneration.
- Lambert-Eaton myasthenic syndrome.[2]
Physical examination may identify enlarged supraclavicular lymphadenopathy, pleural effusion or lobar collapse, unresolved pneumonia, or signs of associated disease such as chronic obstructive pulmonary disease.
Treatment options for patients are determined by histology, stage, and general health and comorbidities of the patient. Investigations of patients with suspected SCLC focus on confirming the diagnosis and determining the extent of the disease.
The procedures used to determine the presence of cancer include the following:
- History.
- Physical examination.
- Routine laboratory evaluations.
- Chest x-ray.
- Chest computed tomography scan with infusion of contrast material.
- Biopsy.
Before a patient begins lung cancer treatment, an experienced lung cancer pathologist must review the pathologic material. This is critical because SCLC, which responds well to chemotherapy and is generally not treated surgically, can be confused on microscopic examination with NSCLC.[4] Immunohistochemistry and electron microscopy are invaluable techniques for diagnosis and subclassification, but most lung tumors can be classified by light microscopic criteria.
(Refer to the Staging Evaluation section in the Stage Information for Small Cell Lung Cancer section of this summary for more information about tests and procedures used for staging.)
Prognosis and Survival
Regardless of stage, the current prognosis for patients with SCLC is unsatisfactory despite improvements in diagnosis and therapy made during the past 25 years. Without treatment, SCLC has the most aggressive clinical course of any type of pulmonary tumor, with median survival from diagnosis of only 2 to 4 months. About 10% of the total population of SCLC patients remains free of disease during the 2 years from the start of therapy, which is the time period during which most relapses occur. Even these patients, however, are at risk of dying from lung cancer (both small and non-small cell types).[5] The overall survival at 5 years is 5% to 10%.[1,5,6,7]
An important prognostic factor for SCLC is the extent of disease. Patients with LD have a better prognosis than patients with ED. For patients with LD, median survival of 16 to 24 months and 5-year survivals of 14% with current forms of treatment have been reported.[1,6,8,9] Patients diagnosed with LD who smoke should be encouraged to stop smoking before undergoing combined-modality therapy because continued smoking may compromise survival.[10]
Improved long-term survival in patients with LD has been shown with combined-modality therapy.[9,11][Level of evidence: 1iiA] Although long-term survivors have been reported among patients who received either surgery or chemotherapy alone, chemotherapy combined with thoracic radiation therapy (TRT) is considered the standard of care.[12] Adding TRT increases absolute survival by approximately 5% over chemotherapy alone.[11,13] The optimal timing of TRT relative to chemotherapy has been evaluated in multiple trials and meta-analyses with the weight of evidence suggesting a small benefit to early TRT.[1,14,15][Level of evidence: 1iiA]
In patients with ED, median survival of 6 to 12 months is reported with currently available therapy, but long-term disease-free survival is rare.
Prophylactic cranial radiation prevents central nervous system recurrence and can improve survival in patients who have had a complete response to chemoradiation.[16,17][Level of evidence: 1iiA]
All patients with this type of cancer may appropriately be considered for inclusion in clinical trials at the time of diagnosis. Information about ongoing clinical trials is available from the NCI Web site.
Cellular Classification of Small Cell Lung Cancer
Before initiating treatment of a patient with small cell lung cancer (SCLC), an experienced lung cancer pathologist should review the pathologic material.
Pathologic Classification
The current classification of subtypes of SCLC includes the following:[1]
- Small cell carcinoma.
- Combined small cell carcinoma (i.e., SCLC combined with neoplastic squamous and/or glandular components).
SCLC arising from neuroendocrine cells forms one extreme of the spectrum of neuroendocrine carcinomas of the lung.
Neuroendocrine tumors include the following:
- Low-grade typical carcinoid.
- Intermediate-grade atypical carcinoid.
- High-grade neuroendocrine tumors including large-cell neuroendocrine carcinoma (LCNEC) and SCLC.
Because of differences in clinical behavior, therapy, and epidemiology, these tumors are classified separately in the World Health Organization (WHO) revised classification. The variant form of SCLC called mixed small cell/large cell carcinoma was not retained in the revised WHO classification. Instead, SCLC is now described with only one variant, SCLC combined, when at least 10% of the tumor bulk is made of an associated non-small cell component.
SCLC presents as a proliferation of small cells with the following morphological features:[2]
- Scant cytoplasm.
- Ill-defined borders.
- Finely granular "salt and pepper" chromatin.
- Absent or inconspicuous nucleoli.
- Frequent nuclear molding.
- A high mitotic count.
Combined small cell carcinoma includes a mixture of small cell and large cell or any other non-small cell component. Any cases showing at least 10% of SCLC are diagnosed as combined SCLC, and SCLC is limited to tumors with pure SCLC histology. SCLC associated with LCNEC is diagnosed as SCLC combined with LCNEC.
Nearly all SCLC are immunoreactive for keratin, thyroid transcription factor 1, and epithelial membrane antigen. Neuroendocrine and neural differentiation result in the expression of dopa decarboxylase, calcitonin, neuron-specific enolase, chromogranin A, CD56 (also known as nucleosomal histone kinase 1 or neural-cell adhesion molecule), gastrin-releasing peptide, and insulin-like growth factor 1. One or more markers of neuroendocrine differentiation can be found in approximately 75% of SCLC.[3]
Although preinvasive and in situ malignant changes are frequently found in patients with non-small cell lung cancer, these findings are rare in patients with SCLC.[4]
Stage Information for Small Cell Lung Cancer
Staging Systems
Several staging systems have been proposed for small cell lung cancer (SCLC). These staging systems include the following:
- American Joint Committee on Cancer (AJCC) Tumor, Node, and Metastasis (TNM).[1]
- Veterans Administration Lung Study Group (VALG).[2]
- International Association for the Study of Lung Cancer (IASLC).[3]
Limited-Stage Disease
No universally accepted definition of this term is available. Limited-stage disease (LD) SCLC is confined to the hemithorax of origin, the mediastinum, or the supraclavicular nodes, which can be encompassed within a tolerable radiation therapy port.
Patients with pleural effusion, massive pulmonary tumor, and contralateral supraclavicular nodes have been both included within and excluded from LD by various groups.
Extensive-Stage Disease
Extensive-stage disease (ED) SCLC has spread beyond the supraclavicular areas and is too widespread to be included within the definition of LD. Patients with distant metastases (M1) are always considered to have ED.[3,4]
IASLC-AJCC TNM Staging System
The AJCC TNM defines LD as any T, except for T3-4, due to multiple lung nodals that do not fit in a tolerable radiation field, any N, and M0.[1] This corresponds to TNM stages I to IIIB. Extensive disease is TNM stage IV with distant metastases (M1) including malignant pleural effusions.[3,4]
The IASLC conducted an analysis of clinical TNM staging for SCLC using the sixth edition of the AJCC TNM staging system for lung cancer. Survivals for patients with clinical stages I and II disease are significantly different from those for patients with stage III disease with N2 or N3 involvement.[3] Patients with pleural effusion have an intermediate prognosis between LD and ED with hematogenous metastases and will be classified as having M1 disease (or ED). Application of the TNM system will not change how patients are managed; however, the analysis suggests that, in the context of clinical trials in LD, accurate TNM staging and stratification may be important.[3]
Staging Evaluation
Staging procedures for SCLC are important in distinguishing patients with disease limited to their thorax from those with distant metastases. At the time of initial diagnosis, approximately two-thirds of patients with SCLC have clinical evidence of metastases; most of the remaining patients have clinical evidence of extensive nodal involvement in the hilar, mediastinal, and sometimes supraclavicular regions.
Determining the stage of cancer allows an assessment of prognosis and a determination of treatment, particularly when chest radiation therapy or surgical excision is added to chemotherapy for patients with LD. If ED is confirmed, further evaluation should be individualized according to the signs and symptoms unique to the individual patient. Standard staging procedures include the following:
- A thorough physical examination.
- Routine blood counts and serum chemistries.
- Chest and upper abdominal computed tomography (CT) scanning.
- A radionuclide bone scan.
- A brain magnetic resonance imaging scan or CT scan.
- Bone marrow aspirate or biopsy in selected patients in which treatment would change based on the results.
The role of positron emission tomography (PET) is still under study. SCLC is fluorodeoxyglucose (FDG) avid at the primary site and at metastatic sites. PET may be used in staging patients with SCLC who are potential candidates for the addition of thoracic radiation therapy to chemotherapy, as PET may lead to upstaging or downstaging of patients and to alteration of radiation fields resulting from the identification of additional sites of nodal metastases.
Evidence (FDG-PET):
|In a study of 120 patients with LD SCLC or ED SCLC, ten patients were upstaged and three patients were downstaged.[5] PET was more sensitive and specific than CT scans for nonbrain distant metastases.
|In a small series of 24 patients with LD by conventional staging, two patients were upstaged to ED.[2] Unsuspected nodal metastases were documented in 25% of patients, which altered the radiation plan in these patients. At this time, sensitivity, specificity, and positive- or negative-predictive value of PET scanning and its enhancement of staging accuracy are uncertain.
Treatment Option Overview for Small Cell Lung Cancer
Chemotherapy and radiation therapy have been shown to improve survival for patients with small cell lung cancer (SCLC).
Chemotherapy improves the survival of patients with limited-stage disease (LD) or extensive-stage disease (ED), but it is curative in only a minority of patients.[1,2] Because patients with SCLC tend to develop distant metastases, localized forms of treatment, such as surgical resection or radiation therapy, rarely produce long-term survival.[3] With incorporation of current chemotherapy regimens into the treatment program, however, survival is prolonged, with at least a fourfold to fivefold improvement in median survival compared with patients who are given no therapy.
The combination of platinum and etoposide is the most widely used standard chemotherapeutic regimen.[4,5,6][Level of evidence: 1iiA] No consistent survival benefit has resulted from platinum versus nonplatinum combinations, increased dose intensity or dose density, altered mode of administration (e.g., alternating or sequential administration) of various chemotherapeutic agents, or maintenance chemotherapy.[7,8,9,10,11,12][Level of evidence: 1iiA]
Radiation Therapy
SCLC is highly radiosensitive and thoracic radiation therapy improves survival of patients with LD and ED tumors.[13,14,15][Level of evidence: 1iiA] Prophylactic cranial radiation prevents central nervous system recurrence and may improve the long-term survival of patients who have responded to chemoradiation therapy [16,17,18][Level of evidence: 1iiA] and offers palliation of symptomatic metastatic disease.
Treatment for patients with limited-stage, extensive-stage, or recurrent SCLC is summarized in Table 11.
Table 1. 1. Standard Treatment Options for Patients With Small Cell Lung Cancer
|Standard Treatment Options
|Limited-stage disease
|Chemotherapy and radiation therapy
|Combination chemotherapy alone
|Surgery followed by chemotherapy or chemoradiotherapy
|Prophylactic cranial irradiation
|Extensive-stage disease
|Combination chemotherapy
|Radiation therapy
|Prophylactic cranial irradiation
|Recurrent disease
|Palliative therapy
Despite treatment advances, the majority of patients with SCLC die of their tumor even with the best available therapy. Most of the improvements in the survival of patients with SCLC are attributable to clinical trials that have attempted to improve on the best available and most accepted therapy. Patient entry into such studies is highly desirable.
Information about ongoing clinical trials is available from the NCI Web site.
Limited-Stage Small Cell Lung Cancer Treatment
Standard Treatment Options for Patients With Limited-Stage Small Cell Lung Cancer (SCLC)
Standard treatment options for patients with limited-stage SCLC include the following:
|Chemotherapy and radiation therapy.
|Combination chemotherapy alone.
|Surgery followed by chemotherapy or chemoradiotherapy.
|Prophylactic cranial irradiation.
Chemotherapy and radiation therapy
Combined-modality treatment with etoposide and cisplatin with thoracic radiation therapy (TRT) is the most widely used treatment for patients with limited-stage disease (LD) SCLC.
Evidence :
Survival. The following results have been reported in clinical trials:
|Length of treatment. The optimal duration of chemotherapy for patients with LD SCLC is not clearly defined, but no improvement exists in survival after the duration of drug administration exceeds 3 to 6 months. The preponderance of evidence available from randomized trials indicates that maintenance chemotherapy does not prolong survival for patients with LD SCLC.[8,9,10,11,12,13,14,15][Level of evidence: 1iiA]
Dose and timing. The optimal dose and timing of TRT remain controversial.
Combination chemotherapy alone
Patients with a contraindication to radiation therapy could be treated with chemotherapy alone. Patients presenting with superior vena cava syndrome are treated immediately with combination chemotherapy, radiation therapy, or both, depending on the severity of presentation.[21,22] (Refer to the PDQ summary on Cardiopulmonary Syndromes for more information.)
Surgery followed by chemotherapy or chemoradiotherapy
The role of surgery in the management of patients with SCLC is unproven. Small case series and population studies have reported favorable outcomes for the minority of LD patients with very limited disease, with small tumors pathologically confined to the lung of origin or the lung and ipsilateral hilar lymph nodes from surgical resection with adjuvant chemotherapy.[23,24,25,26,27][Level of evidence: 3iiiDii] Patients who have undergone surgery and then been diagnosed with SCLC generally receive adjuvant chemotherapy with or without radiation therapy. In patients who receive chemotherapy with radiation therapy, there is no improvement in survival with the addition of surgery.[27][Level of evidence: 3iiiDii] Given the absence of data from randomized trials, the role of surgery in the management of individual patients with SCLC must be considered, both in terms of potential benefit and risk from the surgical procedure.
Evidence :
|A randomized study evaluating the role of surgery in addition to chemoradiation therapy enrolled 328 patients with LD SCLC and found no OS benefit with the addition of pulmonary resection.[28][Level of evidence: 1iiA]
Prophylactic cranial irradiation (PCI)
Patients who have achieved a complete remission can be considered for administration of PCI. Patients whose cancer can be controlled outside the brain have a 60% actuarial risk of developing central nervous system (CNS) metastases within 2 to 3 years after starting treatment.[27,29,30] The majority of these patients relapse only in their brain, and nearly all of those who relapse in their CNS die of their cranial metastases. The risk of developing CNS metastases can be reduced by more than 50% by the administration of PCI.[29]
Evidence :
|A meta-analysis of seven randomized trials evaluating the value of PCI in patients in complete remission reported improvement in brain recurrence, disease-free survival, and OS with the addition of PCI. The 3-year OS was improved from 15% to 21% with PCI.[29][Level of evidence: 1iiA]
|A randomized study (RTOG-0212) of 720 patients with LD SCLC in complete remission after chemoradiation therapy demonstrated that standard-dose PCI (25 Gy in 10 fractions) was as effective as and less toxic than higher doses of brain radiation.[31]
Neurologic sequelae
Retrospective studies have shown that long-term survivors of SCLC (>2 years from the start of treatment) have a high incidence of CNS impairment.[27,30,32,33,34] Prospective studies have shown that patients treated with PCI do not have significantly worse neuropsychological function than patients not treated.[34] The majority of patients with SCLC have neuropsychological abnormalities present before the start of PCI and have no detectable decline in their neurological status for as long as 2 years after the start of their PCI.[34] Patients treated for SCLC continue to have declining neuropsychologic function after 2 years from the start of treatment.[32,33,34] Additional neuropsychologic testing of patients beyond 2 years from the start of treatment will be needed before concluding that PCI does not contribute to the decline in intellectual function.
Treatment options for older patients
The optimal therapeutic approach in older patients remains unclear. A population analysis showed that increasing age was associated with a decreased performance status and increased comorbidity.[35] Older patients were less likely to be treated with combined chemoradiation therapy, more intensive chemotherapy, and PCI. Older patients were also less likely to respond to therapy and had poorer survival outcomes. Whether this was a result of age and its associated comorbidities or suboptimal treatment delivery remains uncertain.
No specific phase III trial in older patients with LD SCLC has been reported; however, three secondary analyses of two cooperative group trials have been published evaluating outcomes in patients aged 70 years or older.[36,37,38] The survival outcomes for the older patients were identical to their younger counterparts in both trials. The older patients experienced more toxic effects, particularly hematologic, compared with younger patients. There was a significant increase in treatment-related mortality in the EST-3588 trial that compared etoposide and cisplatin with either once-daily or twice-daily radiation therapy (1% for patients aged <70 years vs. 10% for patients aged ≥70 years; P = .01).[37] Because the older patients enrolled in these phase III trials may not be representative of LD SCLC patients in the general population, caution must be exercised in extrapolating these results to the general population of older patients.
Treatment Options Under Clinical Evaluation
Treatment options under clinical evaluation for patients with LD SCLC include the following:
- New drug regimens.
- Surgical resection of the primary tumor.
- New radiation therapy schedules and techniques (e.g., timing, three-dimensional treatment planning, and dose fractionation).
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with limited stage small cell lung cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Extensive-Stage Small Cell Lung Cancer Treatment
Standard Treatment Options for Patients With Extensive-Stage Small Cell Lung Cancer (SCLC)
Standard treatment options for patients with extensive-stage SCLC include the following:
|Combination chemotherapy.
|Radiation therapy.
|Prophylactic cranial irradiation.
Combination chemotherapy
Chemotherapy for patients with extensive-stage disease (ED) SCLC is commonly given as a two-drug combination of platinum and etoposide in doses associated with at least moderate toxic effects (as in limited-stage [LD] SCLC).[1] Cisplatin is associated with significant toxic effects and requires fluid hydration, which can be problematic in patients with cardiovascular disease. Carboplatin is active in SCLC, is dosed according to renal function, and is associated with less nonhematological toxic effects.
Other regimens appear to produce similar survival outcomes but have been studied less extensively or are in less common use.
Table 2. 2. Combination Chemotherapy For Extensive-Stage Small Cell Lung Cancer
|Standard treatment
|Etoposide + cisplatin
|Etoposide + carboplatin
|Other regimens
|Cisplatin + irinotecan
|Ifosfamide + cisplatin + etoposide
|Cyclophosphamide + doxorubicin + etoposide
|Cyclophosphamide + doxorubicin + etoposide + vincristine
|Cyclophosphamide + etoposide + vincristine
|Cyclophosphamide + doxorubicin + vincristine
Doses and schedules used in current programs yield overall response rates of 50% to 80% and complete response rates of 0% to 30% in patients with ED.[2,3][Level of evidence: 1iiA]
Intracranial metastases from small cell carcinoma may respond to chemotherapy as readily as metastases in other organs.[4,5]
Evidence (standard regimens):
|Two meta-analyses evaluating the role of platinum combinations versus nonplatinum combinations have been published.
|The Hellenic Oncology Group conducted a phase III trial comparing cisplatin and etoposide with carboplatin plus etoposide.[7] The median survival was 11.8 months in the cisplatin arm and 12.5 months in carboplatin-treated patients.[7][Level of evidence: 1iiA] Although this difference was not statistically significant, the trial was underpowered to prove equivalence of the two treatment regimens in patients with either LD or ED.
Evidence (other combination chemotherapy regimens):
|Irinotecan. Five trials and two meta-analyses have evaluated the combination of etoposide and cisplatin versus irinotecan and cisplatin. Only one of the trials showed the superiority of the irinotecan and cisplatin combination.[8][Level of evidence: 1iiA] Subsequent trials and the meta-analyses support that the regimens provide equivalent clinical benefit with differing toxicity profiles.[9,10,11,12,13,14][Level of evidence: 1iiA] Irinotecan and cisplatin regimens led to less grade 3 to 4 anemia, neutropenia, and thrombocytopenia but more grade 3 to 4 vomiting and diarrhea than etoposide and cisplatin regimens. Treatment-related deaths were comparable between the two groups.
|Topotecan. In a randomized trial of 784 patients, the combination of oral topotecan given with cisplatin for 5 days was not found to be superior to etoposide and cisplatin.[15] The 1-year survival rate was 31% (95% confidence interval [CI], 27%–36%) and was deemed to be noninferior, as the difference of -0.03 met the predefined criteria of no more than 10% absolute difference in 1-year survival.[15][Level of evidence: 1iiA]
|Paclitaxel. No consistent survival benefit has resulted from the addition of paclitaxel to etoposide and cisplatin.[16,17]
Evidence (duration of treatment):
|The optimal duration of chemotherapy is not clearly defined, but no obvious improvement in survival occurs when the duration of drug administration exceeds 6 months.[7,18,19]
|No clear evidence is available from reported data from randomized trials that maintenance chemotherapy will improve survival duration.[20,21,22][Level of evidence: 1iiA] However, a meta-analysis of 14 published, randomized trials assessing the benefit of duration/maintenance therapy reported an odds ratio of 0.67 for both 1- and 2-year overall survival (OS) of 0.67 (95% CI, 0.56–0.79; P < .001 for 1-year OS and 0.53–0.86; P < .001 for 2-year OS). This corresponded to an increase of 9% in 1-year OS and 4% in 2-year OS.[23][Level of evidence: 1iiA]
Evidence (dose intensification):
|The role of dose intensification in patients with SCLC remains unclear.[24,25,26,27,28] Early studies showed that under-treatment compromised outcome and suggested that early dose intensification may improve survival.[24,25] A number of clinical trials have examined the use of colony-stimulating factors to support dose-intensified chemotherapy in SCLC.[26,27,28,29,30,31,32,33,34] These studies have yielded conflicting results.
Factors influencing treatment with chemotherapy
Performance status
More patients with ED SCLC have greatly impaired performance status at the time of diagnosis than patients with LD. Such patients have a poor prognosis and tolerate aggressive chemotherapy or combined-modality therapy poorly. Single-agent intravenous, oral, and low-dose biweekly regimens have been developed for these patients.[30,35,36,37,38,39,40,41]
Prospective, randomized studies have shown that patients with a poor prognosis who are treated with conventional regimens live longer than those treated with the single-agent, low-dose regimens or abbreviated courses of therapy. A study comparing chemotherapy every 3 weeks with treatment given as required for symptom control showed an improvement in QOL in those patients receiving regular treatment.[38][Level of evidence: 1iiDii]
Other studies have tested intensive one-drug or two-drug regimens. A study conducted by the Medical Research Council demonstrated similar efficacy for an etoposide plus vincristine regimen and a four-drug regimen.[39] The latter regimen was associated with a greater risk of toxic effects and early death but was superior with respect to palliation of symptoms and psychological distress.[39][Level of evidence: 1iiC] Studies comparing a convenient oral treatment with single-agent oral etoposide versus combination therapy showed that the overall response rate and OS were significantly worse in the oral etoposide arm.[35,40][Level of evidence: 1iiA]
Subgroup analyses of phase II and phase III trials of SCLC patients by age showed that myelosuppression and doxorubicin-induced cardiac toxic effects were more severe in older patients than in younger patients and that the incidence of treatment-related death tended to be higher in older patients.[41] About 80% of older patients, however, received optimal treatment, and their survival was comparable to that of younger patients. The standard chemotherapy regimens for the general population could be applied to older patients in good general condition (i.e., performance status of 0–1, normal organ function, and no comorbidity). There is no evidence of a difference in response rate, disease-free survival (DFS), or OS in older patients compared with younger patients.
Radiation therapy
Radiation therapy to sites of metastatic disease unlikely to be immediately palliated by chemotherapy, especially brain, epidural, and bone metastases, is a standard treatment option for patients with ED SCLC. Brain metastases are treated with whole-brain radiation therapy.
Chest radiation therapy is sometimes given for superior vena cava syndrome, but chemotherapy alone, with radiation reserved for nonresponding patients, is appropriate initial treatment. (Refer to the PDQ summary on Cardiopulmonary Syndromes for more information.)
Prophylactic cranial irradiation (PCI)
Patients with ED treated with chemotherapy who have achieved a response can be considered for administration of PCI.
Evidence (PCI):
|A randomized trial of 286 patients with response following four to six cycles of chemotherapy compared PCI versus no further therapy with symptomatic brain metastases.[42][Level of evidence: 1iiD
Combination chemotherapy and radiation therapy
Combination chemotherapy plus chest radiation therapy does not appear to improve survival compared with chemotherapy alone in patients with ED SCLC.
Treatment Options Under Clinical Evaluation
Treatment options under clinical evaluation for patients with ED SCLC include the following:
- New drug regimens.
- Alternative drug doses and schedules.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with extensive stage small cell lung cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Recurrent Small Cell Lung Cancer Treatment
Standard Treatment Options for Patients With Recurrent Small Cell Lung Cancer (SCLC)
Standard treatment options for patients with recurrent SCLC include the following:
|Palliative therapy.
At the time of recurrence, many SCLC patients are potential candidates for further therapy.
Although second-line chemotherapy has been shown to produce tumor regression, responses are usually short lived; the median survival is rarely more than 12 months and usually less than 6 months after second-line therapy.[1] Response to first-line chemotherapy predicts for subsequent response to second-line therapy.
As in other chemosensitive tumors (e.g., Hodgkin lymphoma and ovarian epithelial cancer), two main categories of patients receiving second-line chemotherapy have been described: sensitive and resistant. Sensitive patients have a first-line response that lasted more than 90 days after treatment was completed. These patients have the greatest benefit from second-line chemotherapy. Patients with sensitive disease respond to the same initial regimen in approximately 50% of cases; however, cumulative toxic effects may ensue.[2] Resistant patients either did not respond to first-line chemotherapy or responded initially but relapsed within 90 days of completion of their primary therapy.[3] Results from phase II studies of drugs such as topotecan, irinotecan, and gemcitabine indicate that response rates to agents vary depending on whether patients have sensitive, resistant, or refractory disease.[4,5,6,7,8][Level of evidence: 3iiiDii]
Topotecan is standard chemotherapy for recurrent SCLC. Patients with sensitive disease may achieve response to a number of agents including topotecan, irinotecan, taxanes, vinorelbine, paclitaxel, or gemcitabine.[4,5,6,7,8,9,10,11][Level of evidence: 3iiiDii] Response rates to combination agents are generally higher than those reported for single agents;[12,13] however, many studies do not report the patients with sensitive, resistant, or refractory disease.
Evidence (topotecan):
|A randomized comparison of second-line treatment with either cyclophosphamide, doxorubicin, and vincristine (CAV) or topotecan in patients with sensitive disease reported no significant difference in response rates or survival, but palliation of common lung cancer symptoms was better with topotecan.[14][Level of evidence: 1iiC]
|A phase III trial comparing chemotherapy with best supportive care (BSC) in relapsed SCLC patients demonstrated that the addition of oral topotecan to BSC significantly increased overall survival and resulted in better symptom control compared with BSC alone.[15][Level of evidence: 1iiA] The study enrolled 141 patients with chemosensitive or chemoresistant relapsed SCLC who were unsuitable for further standard intravenous chemotherapy. The median survival times for patients receiving topotecan plus BSC were 25.9 weeks versus 13.9 weeks for BSC alone (P = .01).[15]
|A randomized, phase III trial (CWRU-SKF-1598) of 304 patients assessed the use of oral topotecan (2.3 mg/m2 /day for 5 days every 21 days) or intravenous topotecan (1.5 mg/m2 /day for 5 days every 21 days). Confirmed response rates were 18.3% and 21.9%, respectively.[9][Level of evidence: 1iiDii] Secondary endpoints of median survival and 1-year survival rates were also similar (33 weeks vs. 35 weeks and 33% vs. 29%, respectively). Patients receiving oral topotecan experienced less grade 4 neutropenia (47% vs. 64.2%) but more diarrhea of all grades (35.9% vs. 19.9%) than with intravenous topotecan. Quality-of-life (QOL) analysis (using a nonvalidated QOL questionnaire) demonstrated no significant difference between the two arms.
Palliative therapy
Patients with central nervous system (CNS) recurrences can often obtain palliation of symptoms with additional chemotherapy and/or radiation therapy. A retrospective review showed that 43% of patients treated with additional chemotherapy at the time of CNS relapse responded to second-line chemotherapy.[16] The majority of patients treated with radiation therapy obtain objective responses and improvement following radiation therapy.[17]
Some patients with intrinsic endobronchial obstructing lesions or extrinsic compression caused by the tumor have achieved successful palliation with endobronchial laser therapy (for endobronchial lesions only) and/or brachytherapy.[18] Expandable metal stents can be safely inserted under local anesthesia via the bronchoscope, which results in improved symptoms and pulmonary function in patients with malignant airways obstruction.[19]
Patients with progressive intrathoracic tumor after failing initial chemotherapy can achieve significant tumor responses, palliation of symptoms, and short-term local control with external-beam radiation therapy. Only the rare patient, however, will experience long-term survival following salvage radiation therapy.[20]
Treatment Options Under Clinical Evaluation
Treatment options under clinical evaluation for patients with recurrent SCLC include phase I and II clinical trials of new drugs.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent small cell lung cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Changes to This Summary (02 / 19 / 2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
General Information About Small Cell Lung Cancer
Updated statistics with estimated new cases and deaths for 2013 (cited American Cancer Society as reference 3).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of small cell lung cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
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- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Small Cell Lung Cancer Treatment are:
- Janet Dancey, MD, FRCPC (Ontario Institute for Cancer Research & NCIC Clinical Trials Group)
- Giuseppe Giaccone, MD, PhD (National Cancer Institute)
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional. Accessed <MM/DD/YYYY>.
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Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
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For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
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Last Revised: 2013-02-19
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Quick Links
Polling Latinos on climate change
A new poll of Latinos in the United States finds that a large majority — more than four fifths — accept that climate change is real, and that a majority — almost two thirds — accept that climate change is mostly due to human activity.
Extending summer vacation for the sake of creationism?
Will Kentucky extend the duration of summer vacation in order to enable students to attend a creationist attraction?
John Holland dies
The computer scientist John Holland died on August 9, 2015, at the age of 86, according to a memorial notice from the Santa Fe Institute (August 10, 2015).
Need a speaker?
As the only national organization that is wholly dedicated to defending the teaching of evolution and climate change in the public schools, NCSE is the perfect place to find someone to speak to your organization or university about issues relevant to evolution and climate education and attacks on either or both.
NGSS adopted in Iowa
The Iowa Board of Education voted unanimously to adopt the Next Generation Science Standards at its August 6, 2015, meeting.
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subset: commoncrawl


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Special Notes
The sunny floral design on this card remains fixed in colors as shown. When customizing, please note that only three ink colors may be selected for your personalization. Printing in four or more ink colors is available for an additional charge. Please inquire with customer service for more details.
Product Details
- Brand: William Arthur


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Information for Some Vol State Students and Faculty Found Vulnerable on Web Server
Submitted on April 30, 2012 at 10:50 AM
Some 14,000 Volunteer State Community College students and faculty are being notified that some of their personal data was placed on a web server. Based on a review of server logs, it is unlikely that the files have been accessed since 2008, outside of college personnel. Although it's possible that this data could have been accessed by unauthorized individuals on the web, campus officials say they have no direct evidence that it has been discovered or used by anyone maliciously.
There was no credit card or financial information in these files. This is not the main web server, but one where a course instructor would typically post course syllabi and other relevant academic information. A very limited number of faculty files were involved. The files contained names and Social Security numbers. The files were immediately removed from the web server. We want to reiterate that this information was not placed on Vol State's main site, www.volstate.edu. The server in question has been removed from the web.
We believe that most of the affected students are former students. Some of our instructors serve as an adjunct instructor at other institutions, so some information posted included a limited number of students attending other institutions.
"We are notifying the affected students and faculty members as a precaution," said Bruce Scism, interim president. "We have contacted the major credit reporting agencies and informed them that some of our students' and faculty member's personal information may have been accessible. We want to err on the side of caution."
College officials recommend those on the list place a "fraud alert" on their credit files with the major credit bureaus. The alert is a free service that will request that creditors verify an individual's identity before opening a new account. The college also created a web site at www.volstate.edu/securityID to make people aware of the situation and provide information to students about protecting their private information. In addition, all affected students will receive one-year of credit protection from Volunteer State Community College upon request.
"We regret what has happened and apologize for the inconvenience this may cause," Scism said. "Vol State takes the protection of personal information very seriously. The college had policies and employee training sessions regarding the protection of such information. Vol State is reviewing and changing those processes in order to keep personally identifiable information in a secure environment. The college has already implemented several measures that should keep a problem like this from recurring."
A phone number has been set up to handle calls about this matter. It is 615-230-3390. The website, with links to credit agencies, can be found at www.volstate.edu/securityID
# # #
What happened?
Personal data was placed on an academic web server and due to the nature of the server being web-based, the files were not fully protected. This resulted in the possibility that some students' and faculty member's personal data may have been accessible. Upon discovery of the files, the personally identifiable information was immediately removed and the server is no longer on the web.
Who did this?
The web server was primarily used for academic purposes. Typically a course instructor would post the course syllabi and other relevant academic information. Due to having a log in and password, a very small number of employees thought the web server was a secure environment to upload files. Although these could not be readily seen, they were mistakenly put in a vulnerable location. The server is designed to serve as a secondary web location for academic communication and is not a secure file server.
Will the instructors be disciplined?
We are currently investigating the matter and working with each employee involved to address the issue. Our focus now is to let those affected know about the problem and help them resolve this issue.
What kind of information became vulnerable?
Some student and faculty member names and social security numbers were posted on a Vol State web server. The bulk of information had not been accessed since 2008, other than by authorized college personnel. No credit card or financial information was on the server.
Is my information at risk?
Odds are no, but the college has notified every person on the vulnerable lists to err on the side of caution. The information was posted on a web server utilized by faculty and students - not the main www.volstate.edu server.
How will I know if I'm affected?
The college has contacted everyone for whom it can verify personal information was made vulnerable. However, those who receive a letter about the incident should consider protecting themselves as outlined on the Federal Trade Commission web site at http://www.ftc.gov/bcp/edu/pubs/consumer/idtheft/idt04.shtm#CRContact
All affected students may receive one-year of credit protection from Volunteer State Community College upon request.
How did Vol State respond to the problem?
Officials immediately blocked access to the server and removed all files containing the personally identifiable information. This server is no longer available on the web. The college mailed letters to those affected, notifying them of the problem and outlining steps to help prevent possible fraud. The college also contacted the major credit reporting agencies to inform them that some personal information may have been accessible.
What is the college doing to help protect the students?
All affected students and faculty members may receive one-year of credit protection from Volunteer State Community College upon request. In addition, all affected individuals have been advised about how they could protect themselves. Information about contacting credit reporting agencies and creating fraud alert systems was mailed to them and made available on the college's web site, where a link to the Federal Trade Commission site includes detailed instructions on what to do to avoid identity theft and fraud.
Have the appropriate people or agencies been notified by the college?
Yes, the college notified major credit agencies to inform them that some students' personal information may have been accessible.
What is being done to make sure it doesn't happen again?
We'll make every effort to ensure it doesn't happen again. All files of concern have been removed from the server and the server has been removed from the web.
What can I do if I'm concerned about protecting my personal information?
The Federal Trade Commission recommends that you call the toll-free fraud number of any of the three nation-wide consumer reporting companies and place an initial fraud alert on your credit reports. An alert can help stop someone from opening new credit account in your name.
• Equifax
P.O. Box 740241, Atlanta, GA 30374-0241
• Experian
P.O. Box 9532, Allen, TX 75013
• TransUnion
Fraud Victim Assistance Division, P.O. Box 6790, Fullerton, GA 92834-6790
You are entitled to order free copies of your credit reports, and, if you ask, only the last four digits of your SSN will appear on your credit reports. Once you get your credit reports, review them carefully. Look for inquiries from companies you haven't contacted, accounts you didn't open, and debts on your accounts that you can't explain. Check that information, like your SSN, address(es), name or initials, and employers are correct. If you find fraudulent or inaccurate information, get it removed. For more details about protecting your identity, visit the Federal Trade Commission website at http://www.ftc.gov/bcp/edu/pubs/consumer/idtheft/idt04.shtm#CRContact
A service provided by the Office of Public Relations.


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Documenting how to localize Gaia
Jeff Beatty
Everyone is eager to get their hands on Firefox OS in their own language. Since Firefox OS will land in the Brazilian market first, localization is a very high priority. Some l10n teams have already hit the ground running with … Continue reading


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Drawing Room Collection by Feiss
Any room can be transformed into an elegant turn-of-the-century parlor by adding light fixtures from the Drawing Room Collection by Feiss. Choose from a variety of chandelier, semi-flush, sconce, vanity and pendant lighting styles. Inspired by an artisanal aesthetic, each fixture features elaborate walnut scrollwork. Included are light amber shades crafted of scavo glass.


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- "I do not go down so easy."
- ―Kalem to Niko Bellic.
Kalem is a character in the Grand Theft Auto series, appearing as a minor character in Grand Theft Auto IV.
The voice actor for Kalem is unknown, as he isn't credited.
Kalem is an Albanian criminal based in Broker, Liberty City. He is an enforcer for the Albanian Mob and associated with Dardan Petrela and Bledar Morina, two higher ranking members of the mob. He appears to serve as an extra muscle in their loan sharking business.
Events of GTA IV
- "I will beat you like I beat your cousin!"
- ―Kalem to Niko.
When Roman Bellic, who owes money for Dardan, can't repay the debt, Bleder and Kalem take him out to the basketball courts in Firefly Projects, and begin to beat him out, despite Roman's begs that he didn't mean to had Dardan attacked in a previous incident.
Roman's cousin - Niko Bellic - shortly arrives to the place where he confronts Kalem and Bleder. Bleder orders Kalem to keep an eye on Roman while he'll deal with Niko. When Bleder falls against Niko, Kalem decides to attack Niko, but is killed as well, during a fist fight.
- Bleed Out (Killed)
- Kalem means 'pencil' in Turkish.
- Unlike other criminals in GTA IV, including his associates, Kalem doesn't have an LCPD record.
- Kalem has a very similar model to Preston Pecinovsky, another member of the Albanian Mob who appears as a target in the "Most Wanted" side-missions. Also, in the online mission, "Bomb Da Base II", some of the members aboard the ship resemble Kalem.
- Kalem's jacket is almost identical to the Albanian biker jacket unlocked in "I Need Your Clothes, Your Boots, and Your Motorcycle", but with a red sleeveline instead of black.
- Kalem may shout during his fight with Niko that he is a brother of Dardan.
- Kalem is most likely a Muslim Albanian this is guessed by his name "Kalem" has Muslim origins and Albania has a high population of people that ahere to the religion of Islam. More than half the population follows Islam infact it is the largest religion in Albania. This might have been done so Rockstar could add realism to the game.
- ↑ Given the fact that both Dardan and Bleder were born in Albania, it can be assumed that the same goes for Kalem


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this wiki
- "Experience has taught me that a man like you can be loyal for the right price...but groups of men can get greedy."
- ―Donald Love.
Donald Love is a character in Grand Theft Auto series who appear as a main character in Grand Theft Auto III (set in 2001), a minor character in Grand Theft Auto: Vice City (set in 1986) and a central character in Grand Theft Auto: Liberty City Stories (set in 1998). He is the multi-billionaire owner of the Love Media conglomerate and is also involved in construction and real estate industries. In GTA III he is voiced by Kyle MacLachlan, who has also appeared in Desperate Housewives, and in GTA Liberty City Stories by Will Janowitz, who has also appeared in The Sopranos. The voice actor for Donald Love's appearance in GTA Vice City is not credited.
He became the protegé of real estate expert Avery Carrington, often following him with a note pad and pen, including to one of Colonel Cortez' parties and once met Tommy Vercetti, who Avery was hiring to start a gang war between the Cubans and the Haitians. Avery's willingness to use any method to bring down property prices would leave an impression on Love. At some point between 1986 and 1998 he moved to Liberty City and established himself as a successful businessman, starting the Love Media company, purchasing a building in Bedford Point and opening an import garage.
Donald Love enters the race to become the mayor of Liberty City, following the murder of incumbent Roger C. Hole, running against Miles O'Donovan. He begins to work for Leone Family Don Salvatore Leone and uses Toni Cipriani, who killed Mayor Hole, and uses his wealth to his advantage. Love hires Cipriani to first stealing a corpse for Love to eat, before having him campaign for him and kill some of O'Donovan's campaigners. Love then discovers that the Forelli Family, a rival to the Leone Family who had controlled Mayor Hole, own a stake in the company printing the ballot papers, sending Toni to destroy the printing factory. Love, realising the voting is closed, decides to campaign himself but is almost killed by the Forelli Family in an ambush, but is rescued by Cipriani, who later attempts to rig the election.
Love later discovers that O'Donovan has evidence linking him with the Leone Family and sends Toni to destroy the evidence. The links between Love and the Leone Family, however, are too obvious and the election is won by O'Donovan. Love, having spent all his money on his campaign, is forced to move to a flophouse in Pike Creek, Shoreside Vale. Love, however, does not give up and later employs Cipriani to kill former mentor Avery Carrington to steal his re-development plans for Fort Staunton, killing many Colombian Cartel escorts as well, before killing Liberty Tree reporter Ned Burner, who had witnessed the murder. Cipriani later collects the corpses of both Carrington and Burner for Love to eat.
Donald Love also hires Cipriani to destroy the Fort Staunton district of Staunton Island, a Forelli strong hold, which he does, using explosives provided by 8-Ball. Love, confident of his future success, purchases a mansion in Cedar Grove and locks himself away, fearing a reprisal from the Colombian Cartel, who attempt to kill him but they are thwarted by Cipriani, who takes him to his private jet at Francis International Airport, where the bodies of Carrington and Burner are in storage. By 2001, the same mansion is taken over by the Cartel, while Donald Love seeks to live in the Love Media tower to avoid certain taxes.
Life until October 2001
Donald Love flies to Los Santos and continues to expand his business, also living on a yacht in the Caribbean. He is known to have changed laws, been involved in slum clearance and opened casinos across the United States, in the process becoming a "legend" according to a Liberty Tree report. He returns to the city in March 2001, following the return of fellow businessman and rival Barry Harcross, and begins to expand his business empire in the city. He re-establishes Love Media and purchases over nine hundred radio stations (including Chatterbox FM, Double Clef FM, Flashback 95.6 and Head Radio), three hundred television stations, four networks, three satellites, ten senators, the Liberty Tree newspaper, the Bitch'n' Dog Food company and the thirty-story Love Media Building in Bedford Point. He also hires an Old Oriental Gentleman to teach him Tai Chi, sending a private plane to bring him to the city, although the man is arrested by the immigration chief Ray Mathers. At some point between 1998 and 2001, Love begins to implant his plans redevelop Fort Staunton with the Colombian Cartel and their front company, Panlantic Construction, suggesting he had paid the Cartel off.
October 2001
Donald Love continues to oversee the development of Fort Staunton and run his media conglomerate from his home in Bedford Point, although his old oriental gentleman is kidnapped by the Cartel whilst he was being transferred to a police station in Portland View, Portland Island. He later hires Claude, who also escaped in the ambushed convoy, to rescue the old oriental gentleman from a Cartel hide out in Aspatria, before having him kill Yakuza co-leader Kenji Kasen, whilst disguised as a Cartel gangster, in order to provoke a gang war between the two to drive down property prices. Claude is then sent to collect decoy packages before being sent to collect the real package, eventually going to a construction site in Fort Staunton where he finds ex-girlfriend and Cartel leader Catalina, with Miguel and the package. He retrieves the package for Love and works for him one last time, acting as a decoy to allow the old oriental gentleman to escape with the package. Love later disappears with the old oriental gentleman, with Rockstar Games stating themselves that Love's fate is ambiguous.[1]
Donald Love is a cannibal, as seen during the mission Cam Pain, where he eats human ribs and describes human flesh as being "like chicken" but "more sentient". He is also known to throw morgue parties, as revealed in both GTA III and GTA Liberty City Stories, even having Toni Cipriani steal the corpses of Avery Carrington and Ned Burner to eat.
In GTA Liberty City Stories, he is much more flamboyant, and still looks to be very young. Only 3 years later, in GTA III, he has a much deeper, more mature voice, puts on some weight and appears to be more towards his forties.
- One of Donald Love's lines in GTA III is almost exactly replicated in GTA Vice City by his mentor Avery Carrington, although the events occur the other way around in the game universe. Love states, during the mission Waka-Gashira Wipeout, that "Nothing drives down real estate prices like a good old fashioned gang war, apart from the outbreak of a plague, but that might going too far in this case". While during the mission Two Bit Hit in GTA Vice City, Avery Carrington states "Now, nothing brings down real estate prices quicker than a good old-fashioned gang war - 'cept maybe a disaster, like a biblical plague or something, but, that may be going too far in this case".
- Some newspapers in Grand Theft Auto IV carry images of Donald Love.
- Donald was scheduled to have a bigger part in Grand Theft Auto: Vice City.
- Love's portrayal in Liberty City Stories closely resembles Donald Trump, Jr., son of real-life retail tycoon and billionaire Donald Trump.
Mission appearances
- Liberator (Boss)
- Waka-Gashira Wipeout (Boss)
- A Drop In The Ocean (Boss)
- Grand Theft Aero (Boss)
- Escort Service (Boss)
- Decoy (Boss)
- Love's Disappearance (Boss/Disappearance)
- GTA Vice City
- GTA Liberty City Stories
- The Morgue Party Candidate (Boss)
- Steering the Vote (Boss)
- Cam-Pain (Boss)
- Friggin' the Riggin' (Boss)
- Love and Bullets (Boss)
- Counterfeit Count (Boss)
- Munitions Dump (post-mission phone call)
- Love on the Rocks (Boss)
- Dead Reckoning (Post-mission phone call)
- Panlantic Land Grab (Boss)
- Stop the Press (Boss)
- Morgue Party Resurrection (Boss)
- Bringing the House Down
- Love on the Run (Boss)
- ↑ http://www.rockstarbase.com/asked-answered-re-episodes-from-liberty-city-yusuf-amir-donald-love-and-l-a-noire


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(Undated)- Emily Spencer, Tessa McGill, and Megan Steenhuysen all earned major postseason accolades on Thursday night as the Summit League announced their annual All-League awards.
Tessa McGill was named Defensive Player of the Year, Megan Steenhuysen was honored as the Setter of the Year and sophomore Emily Spencer took the top honor of the night as she was named Summit League Player of the Year. All three players were also named All-League. There are no first and second all-league teams this year, instead the Summit League voted for honorable mention selections. Senior Jessie Manwaring was listed as an honorable mention selection and the final Mastodon to earn an award was red-shirt freshman Hailie Ripley who made the All-Freshman Team.
The Mastodons are currently in Fargo, N.D. for the Summit League Volleyball Championship Tournament. They will face Oakland tomorrow in a semifinal match that begins at 6 p.m. The winner will face either IUPUI or Kansas City in the championship match that will be played on Saturday, Nov. 17 at 8 p.m.
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FORT WAYNE, Ind. (21Alive) -- It's a new tool for accessing information on a growing problem in the Hoosier state - meth.
In 2013, Indiana held an alarming record, the highest number of meth busts: 1,808.
For more information on how to see where and when those seizures occured, along with police reports, click the video link above.
What are your thoughts CLICK HERE to leave us a "QUESTION OF THE DAY" comment.
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text: While weather vanes are a folk art that originated in Europe, the craft reached its greatest development in America. We worked closely with the esteemed American Folk Art Museum in New York, established to honor folk art as a vital element in American cultural history, to re-create this stamped-tin weather vane from their collection. Our reproductions have the green patina of oxidized copper.


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"Colleen had the challenge of combining our living room/dining room/kitchen on a budget. The result was a very functional and warm space. It has literally brought our family together!"
- Barb P
Eagan, MN
Colleen Fox Slack | email: email@example.com | phone: 612.868.0348
Copyright © Fox Interiors. All Rights Reserved.
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You may be a long way from Kansas, but you'll be right at home wearing one of our fun Dorothy Costumes. The story of Dorothy and the Wizard of Oz was first brought to us way back in 1900 when it was first published. The timeless tale then moved from the pages to the film reel with Judy Garland's famous 1939 adaptation of the story and then again with the revamped story of the prequel, Oz the Great and Powerful, which was released in 2013. Dorothy is still a wildly popular character today and dressing up as her is a fantastic Halloween costume idea. Browse through this collection of Dorothy and other Wizard of Oz related ensembles to find the perfect one for you.
This category has a lot to choose from. We offer Dorothy themed ensembles in a number of different interpretations, so you are sure to find one you love. Our variations on the Dorothy outfit feature authentic replications that are officially licensed products and others that take some artistic liberties, turning Dorothy into a sexy Halloween outfit. This selection includes a wide array of outfits varying in quality, detail, and style so you can select your favorite. We also sell Dorothy outfits for little kids as well.
This category also includes outfits for side characters. You can dress up like the Tin Man, Scare Crow, or Cowardly Lion with some of these fun and eye catching ensembles. We also have Good Witch and Wicked Witch ensembles and some fun props and accessories to help you really get in character, like Dorothy's sparkling red shoes or a Toto in a Basket prop. You will also be able to find officially licensed outfits from the new Oz the Great Powerful film


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The Pullman Madrid Airport & Feria has 179 rooms from which guests can choose Classic, Superior or Executive Rooms or Suites. Located close to the IFEMA and the Municipal Congress Hall. Easily accessible from the M40 highway (exit 8). Ideal for seminars and conferences (5 meeting rooms), featuring the Mare Nostrum restaurant, bar, Andalusian style courtyard and outdoor pool (check opening times), fitness center, free WIFI and paid parking. Free transfers to the airport (check timetables).
- Check-in:14:00
- Check-out:12:00
Services offered by the hotel
- . Connectivity Lounge
- . Fitness Lounge
- . Access to the pool
- . Airport shuttle
- . Free accommodation and breakfast for 1 child under 12 years old sharing parents' room, on request with the hotel. To confirm availability of an extra bed, please contact the hotel directly before arrival.


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The vagina is elastic in nature, and it will generally reshape and become tight after anything that stretches it out, namely sexual intercourse. However, many women experience a loose vagina, and there are many reasons for why this problem occurs.
This article will explore the major causes of a loose vagina so that you know why you are experiencing this problem. There are many creams, operations and exercises that you can do to fix this problem, and most of them are quite effective if you are persistent.
#1: Childbirth
One of the most common reasons for a loose vagina is childbirth. A child is massive compared to anything else that will pass through your vagina, so it's understandable why this is one of the causes of a loose vagina. At the same time, many women go right back to normal after a few weeks.
The main thing that causes vaginal loosening is trauma experienced during childbirth. If the birthing went smoothly and there were no complications, then you have a higher chance of your vagina going back to normal after recovery. If the area is too narrow and doctors perform an episiotomy (a procedure that widens the area so that a child can easily come out), then there is a good chance that you will have some loosening. This is normally only done if the baby is blocked, or is having a very hard time coming out.
#2: Hormonal and Malnutrition Problems
If you have any hormonal problems (such as menopause from aging or high testosterone), then you might also have a loose vagina. The vagina will usually become dry and sex might be painful, and the vagina also has a high chance of becoming loose.
Malnutrition can also cause this because the vagina is not getting the proper amount of energy that it needs. This means that the body is repurposing all of the food intake so that you stay alive. Your vagina (along with many other parts of your body, like teeth and hair) will suffer because there simply aren't enough calories, vitamins and minerals to keep everything in tip-top shape. The vaginal walls will lose their strength and elasticity, and thus will sag and become loose.
If you are experiencing hormonal issues, then you should see a doctor to get a prescription, or you should change your diet so that your body naturally creates more estrogen. A dietitian should be able to help you find the right foods to naturally fix this problem. This will also help with malnutrition. You need to eat a balanced diet to make everything work properly.
#3: Aging
As stated above, older women who are menopausal often have loose vaginas due to the resulting hormonal problems, but aging is one of the causes of a loose vagina even if you aren't menopausal. Just like how your skin will naturally sag even if you take great care of yourself, so will the vaginal walls. This just naturally happens, and some women experience it more than others.
If this is occurring due to your age, regardless of whether or not you have menopause, you can usually fix it by using excises (general exercise and Kegel exercises) and eating a better diet to ensure that your vagina gets all the nutrients it needs.
There are many causes of a loose vagina, but thankfully this problem isn't too difficult to fix. There are many creams that can naturally increase the strength of your vaginal walls, and you can do certain exercises that directly target this area. If neither work, then there are surgical procedures that can also help, but you should save those for last because they are expensive, and they may sometimes make the problem worse.
If you're interested in trying a natural tightener you can read reviews of some of the more popular products below.
- Intivar Female Renewal Gel Review
- IsoSensuals TIGHT Review
- VieNue Vivify Review
- 2Seduce Female Tightening Gel Review
- ViaTight Tightening Gel Review
- PK24 Review Intimate Tightener


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Customising the JA Purity template
From Joomla! Documentation
Revision as of 13:54, 15 May 2010 by Richard.krone (Talk | contribs)
This article or section is in the process of an expansion or major restructuring. You are welcome to assist in its construction by editing it as well. If this article or section has not been edited in several days, please remove this template.
This article was last edited by Richard.krone (talk| contribs) 5 years ago. (Purge)
- 1 Introduction
- 2 Template Layout
- 3 Customisation - Basics
- 4 Customisation - Intermediate
- 5 Customisation - Advanced
- 6 Known Issues and Bugs
- 7 See also
JA Purity is a highly customizable template available by default in the standard Joomla 1.5 installation. JA Purity was designed by JoomlArt.com and features the following:
- Screen width configuration (Fluid / Narrow / Wide-screen / Fixed in pixel or percentage)
- Multiple colors schemes (Red, Green, Blue and Black)
- Well Structured, xHTML/CSS validated and SEO-optimized source
- Cross-browser support for Internet Explorer 6+, Firefox, Safari, and Opera
If you have a support question about the JA Purity template check for a solution on the following forum.
Before You Start
Before you start hacking away at the default installed JA_Purity template you may want to do ONE of the following:
Option One:
- Create a new directory templates/my_japurity
- Copy the contents of the original ja_purity directory to the my_japurity directory.
- Go to the administrator/language/en-GB directory and copy en-GB.tpl_ja_purity.ini to en-GB.tpl_my_japurity.ini
- Go to the language/en-GB directory and copy language/en-GB/en-GB.tpl_ja_purity.ini to en-GB.tpl_my_ja_purity.ini
- Open the templateDetails.xml file in the my_japurity directory and change ALL references for the original ja_purity directory to the new directory my_japurity.
<language tag="en-GB">en-GB.tpl_ja_purity.ini</language>
<language tag="en-GB">admin/en-GB.tpl_ja_purity.ini</language>
<param name="theme_header" type="folderlist" directory="templates/ja_purity/styles/header" default="" label="Header Themes" description="HEADER THEMES DESCRIPTION" />
<param name="theme_background" type="folderlist" directory="templates/ja_purity/styles/background" default="" label="Background Themes" description="BACKGROUND THEMES DESCRIPTION" />
<param name="theme_elements" type="folderlist" directory="templates/ja_purity/styles/elements" default="" label="Primary Elements" description="PRIMARY ELEMENTS DESCRIPTION" />
Option Two:
- Download the tutorial template. Once you download the archive, rename it as my_japurity.zip and then log into the Administration area of your Joomla site and install the template.
Doing one of these options will save you from worrying about any future updates to the Joomla source code that might overwrite your existing edits. This tutorial is based on the latest template version as of Joomla version 1.5.11.
Template Layout
Here's the directory structure for the template. Click to see a description of the directory contents (if available) <imagemap> Image:JA_Purity_directories.jpg default Ja purity directory structure desc bottom-left </imagemap>
Front Page
Click on the picture to see the descriptions (if available) <imagemap> Image:JA_Purity_Tutorial_Main.png|640px rect 19 9 220 67 Customise the Logo rect 253 9 1102 67 Customise the Header Background rect 1140 13 1197 34 Customise Accessibility rect 1113 40 1265 64 Customise Searching rect 0 76 279 657 Customise - Module Position Left rect 278 76 1002 657 Customise - Main Content Area rect 1002 76 1280 657 Customise - Module Position Right rect 0 657 1280 817 Customise - Spotlight Area rect 0 817 1280 1024 Customise - Module Position Footer rect 0 0 1280 73 Customise Header Area default Customising the JA Purity template desc bottom-left </imagemap>
User 1
User 2
User 3
User 4
User 5
CSS Files
Customisation - Basics
Administration Features
Enable Horizontal Navigation Menus with drop down menus
Customise Module Position and Content
Customise - Header Area
Customise - Module Position Left
Customise - Main Content Area
Customise - Module Position Right
Customise - Spotlight Area
Customise - Module Position Footer
Customise the Logo
Customise the Logo
Change the Position of Your Logo
Use one image for Header and Logo
Customise the Header
Customise the Header Background Images
Change the Size of the Header
Add or Change the Header Color Scheme
Remove the rotating header graphics
Customise the Favicon
Center the Horizontal Menus
Change the Color of the Horizontal Menus
Use a Gradient Image for the Background in the Horizontal Menus
Allow Right to Left language use of Horizontal Menu
Customisation - Intermediate
Customise Accessibility
Customise Searching
Customisation - Advanced
Known Issues and Bugs
- IE8 Compatibility - SEE: http://forum.joomla.org/viewtopic.php?f=541&t=393631&p=1709079&hilit=ie8#p1709079
- Active Menu item not updating. SEE: http://forum.joomla.org/viewtopic.php?f=466&t=396625
- PROBLEM: When Joomla cache is enabled reference Joomla 1.5.10 and before) and clicking a menu item it doesn't change color. It is impossible to understand which is the active menu item. SOLUTION: for now the only solution is to disable the cache function in the mod_mainmenu: go to 'Tools>Module Manager' and select the 'Main Menu' module (type=mod_mainmenu). Under 'Parameters>Advanced Parameters' select 'Caching>No Caching'. SEE: http://forum.joomla.org/viewtopic.php?f=541&t=378584


text:
The Power of Independent Thinking
Robert Higgs on FDA and Consumer Welfare
Recorded: Wednesday, July 23, 2014
This presentation by Independent Institute Senior Fellow Robert Higgs was presented on July 24, 2014, at Mises University, sponsored by the Ludwig von Mises Institute, in Auburn, Alabama.
Experts: Robert HiggsType: Other EventIssues: Economists, Free Market Economics, Government Power, Regulation and Deregulation
Robert Higgs: The Welfare State
Recorded: Tuesday, June 17, 2014
Robert Higgs discusses the rise of the welfare state in the United States.
For information on The Challenge of Liberty Summer Seminar, click here.
Experts: Robert HiggsType: Challenge of Liberty SeminarsIssues: Bureaucracy and Government, Corporate Welfare, Economic History and Development (International), Economic History and Development (U.S.), Economic Policy, Free Market Economics, Government Power, Government Waste/Pork, History (U.S), Labor and Employment, Political Ideology and Philosophy, Regulation and Deregulation, Social Security, Welfare
Robert Higgs - Crisis, Leviathan, and the National Security State
Recorded: Thursday, February 27, 2014
"Crisis, Leviathan, and the National Security State" by Robert Higgs was a speech sponsored by The Future of Freedom Foundation February 15, 2014 at the 2014 International Students for Liberty Conference in Washington D.C.
Experts: Robert HiggsType: TelevisionIssues: Constitutional Law, Defense and Foreign Policy, Economic Policy, Free Speech, Freedom, Government Power, History (U.S), Nationalism, Political Ideology and Philosophy, Politics, Privacy, Terrorism and National Crises
Robert Higgs on Regime Uncertainty Past and Present
Recorded: Friday, February 21, 2014
Senior Fellow and author Robert Higgs speaks with Caleb Brown of the Cato Institute on the subject of Regime Uncertainty Past and Present.
Experts: Robert HiggsType: RadioIssues: Constitutional Law, Culture/ Society, Government Power, History (International), History (U.S), Political Ideology and Philosophy
Robert Higgs on the Logic of Crisis and Leviathan and Why It Still Holds
Recorded: Monday, February 17, 2014
On February 17, 2014 Robert Higgs presented this speech as part of the ongoing Economic Liberty Lecture Series, a joint project of The Future of Freedom Foundation and the George Mason University Economics Society.
Check out Higgs' book Crisis and Leviathan.
Experts: Robert HiggsType: TelevisionIssues: Bureaucracy and Government, Civil Liberties/ Human Rights, Freedom, Government Power, Political Ideology and Philosophy, Politics, Privacy
The State Is Too Dangerous to Tolerate
Recorded: Saturday, July 27, 2013
Robert Higgs, Senior Fellow at the Independent Institute and author of Delusions of Power, speaks at the 2013 Mises University, hosted by the Mises Institute in Auburn, Alabama, on 27 July 2013.
Experts: Robert HiggsType: TelevisionIssues: Civil Liberties/ Human Rights, Defense and Foreign Policy, Government Power, Political Ideology and Philosophy
Robert Higgs Discusses Independence Day on the Scott Horton Radio Show
Recorded: Thursday, July 4, 2013
Senior Research Fellow Robert Higgs talks with Scott Horton about his classic The Transformation of the American Economy 1865-1914; the July 4th celebration of statism and American mythology. Check out some of Robert Higgs books mentioned on the program.
Experts: Robert HiggsType: RadioIssues: Culture/ Society, History (U.S), Nationalism, Political Ideology and Philosophy
State, War and Economy
Recorded: Tuesday, August 28, 2012
Senior Fellow Robert Higgs, author of Delusions of Power, is interviewed on The Lew Rockwell Show, about the delusions of government power and U.S. interventionism.
Experts: Robert HiggsType: RadioIssues: Bureaucracy and Government, Defense and Foreign Policy, Free Market Economics, Government Power, Political Ideology and Philosophy


text:
Tags: Rap Genius, Health Genius, News Genius, community engagement online, Plan B, pink slime, Jay-Z, 2PAC, lyric interpretation, online health community
Live Toast is an entertainment blog brought to you by the creative team at Ticket Liquidator.
Please note the writers' views are entirely their own and may not reflect the views of Ticket Liquidator, LLC.
Follow Ticket Liquidator on Facebook
Any trademarks that appear on Live Toast remain the property of their respective owners. The appearance of trademarked terms does not indicate any association with TicketLiquidator.com or Ticket Liquidator, LLC.
© 2002 - 2013 Ticket Liquidator is a registered trademark of Ticket Software LLC.


text:
Scroll to Previous Item
Scroll to Next Item
Espresso Sabrina Basket Collection
Set Savings
Great Value
Create a place to store toys, books and more with our sturdy Sabrina Baskets.
Medium: 12" square top, 9" square bottom x 6" high
Large: 12" square top, 9" square bottom x 9.5" high
X-Large: 17" square top, 14" square bottom x 9" high
Woven of sustainable rattan, a fiber known for its strength and longevity.
Available in a variety of sizes to fit any storage need.
Simply designed to work in any child's room, regardless of age.
Baskets sold individually or as a set of 2.
Click on swatches below to view all colors and sizes.


text:
JE117: A Tyrogue Full of Trouble
Revision as of 00:17, December 31, 2013 by Lucasmoura (Talk | contribs)
12,920pages on
this wiki
this wiki
While the gang heads to Mahogany Town via going through Mt. Mortar, Ash and co. notice a Tyrogue on the path, which after refusing to eat some food, steals all the Pokémon food Brock had, accompanied by a Mankey and a Primeape, and knocked a boulder off its ledge. The gang are then saved by a man named Kiyo and his two Pokémon Hitmonlee and Hitmonchan. He explains that he's been trying to befriend the Tyrogue only to have every plan backfire. It has to be because Tyrogue doesn't trust humans. How can Kiyo convince Tyrogue to change his mind?
- Originally, this episode was going to be called "Fit to be Tyrogued".
- Dexter erroneously states that Tyrogue is the evolved form of Hitmonlee and Hitmonchan. This is incorrect, as Tyrogue is the baby form of Hitmonlee, Hitmonchan, and Hitmontop.
- Kiyo says that he is entering the P1 Grand Prix, yet neither Ash, Misty or Brock seem to recall they had already been to one or that Brock and Ash entered it or even that Ash won the P1 Grand Prix with his Primeape.
|This article is an anime stub.
Please help the Pokémon Wiki by expanding it.
| This article has an incomplete plot or synopsis.
Reason: N/A
Please help the Pokémon Wiki by expanding it.


text:
Multiline Retail
Company Overview of Family Dollar Stores Inc.
BOARD MEMBERS AFFILIATED WITH Pamela S. Lewis Davies Ph.D.*
President and Director
*Data is at least as current as the most recent Definitive Proxy.
MOST CONNECTED PEOPLE TO Pamela S. Lewis Davies Ph.D.
|Sharon L. Allen
|205 Relationships
|Jed W. Bernstein
|159 Relationships
|David C. Darnell
|132 Relationships
|Janice Reals Ellig
|115 Relationships
|Wright L. Lassiter
|99 Relationships
Sponsored Financial Commentaries
Sponsored Links
Request Profile Update
Only a company representative may request an update for the company profile. Documentation will be required.
To contact Family Dollar Stores Inc., please visit . Company data is provided by Capital IQ. Please use this form to report any data issues.
Please enter your information in the following field(s):
Your requested update has been submitted
Our data partners will research the update request and update the information on this page if necessary. Research and follow-up could take several weeks. If you have questions, you can contact them at email@example.com.


text: Quick View Monkey Bingo by Popular Playthings $22.95 In stock online Monkey Bingo is the exciting new way to play bingo. Just one look at the amusing dispenser, colorful animal tiles, two-sided bingo cards, transparent monkey chips and you know you're in for some serious fun. To play, just load the sixteen animal tiles into the banana crate and have each player… See Details was


text:
May 5, 2016
SHERMAN, TX -- News 12 was honored to be recognized by local veterans Friday afternoon.
The Vietnam Veterans of America, Chapter 973 presented a certificate of appreciation to our own Kristen Shanahan, Nicolette Schleisman, and Morgan Downing.
Our News Director Matt Griffin also accepted an award on behalf of News 12.
The veterans say they just wanted to show their appreciation for efforts to support and promote Veterans issues in the Texoma Area.
Click Here to access the online Public Inspection File
Viewers with disabilities can get assistance accessing this station's FCC Public Inspection File by contacting the station with the information listed below. Questions or concerns relating to the accessibility of the FCC's online public file system should be directed to the FCC at 888-225-5322, 888-835-5322 (TTY), or email@example.com.


text:
- From 01 Sat Jun 2013 to 03 Mon Jun 2013 June 1, 2013 June 3, 2013 Cheeca Lodge & Spa
Islamorada Dolphin Tournament
Hosted by the Islamorada Charterboat Association, this annual event is headquartered at Whale Harbor Marina with $15,000 in prize money. Competition is open to all anglers and there is no limit on the number of anglers that can participate. Call Dianne Harbaugh at 305-852-2102 or e-mail firstname.lastname@example.com.


text:
Figure 2: Mean number of reported physically unhealthy days in the past 30 days by state
The map presents the mean number of reported physically unhealthy days in the past 30 days by state using the 2009 BRFSS.
The physically unhealthy days question is one of four core health-related quality of life measures that have been monitored by states since 1993 using the BRFSS. The question asks "Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?"
Data Source: The Behavioral Risk Factor Surveillance System (BRFSS) 2009
Projection: Albers Equal Area Conic
(A text description of this map is also available.)
Back to HRQOL Tables and Maps
Get email updates
To receive email updates about this page, enter your email address:
Contact Us:
- Centers for Disease Control and Prevention
Health Related
Quality of Life
Surveillance Program
1600 Clifton Rd
Atlanta, GA 30333
Closed Holidays
- Contact CDC-INFO


text:
October 7, 2010
Adam Gorney
Rivals.com Basketball Recruiting
Torren Jones hasn't even started his sophomore basketball season but one Pac-10 school has already verbally offered and many other national programs are involved. ...More... To continue reading this article you must be a member. Sign Up Now!
Already a member? Click here to sign in


text:
Gain the benefits of a unified approach to IAM
Eliminate the complexities and time-consuming processes that are often required to govern identities, manage privileged accounts and control access. Dell One Identity solutions help simplify and achieve business agility while addressing your identity and access management (IAM) challenges.
- Define a clear path to governance, access control, and privileged management
- Empower the business, not IT, to make access decisions
- Become future-ready as your organization evolves with our "configure, don't code" solutions
- Leverage modular, integrated components to start anywhere and build from there
- Rapidly deploy and achieve ROI in weeks, not months or years


text:
Shopping bag
View shipping rates
Shipping Information
Item Availability
All items available for sale on the dressbarn.com website are expected to be in stock and available for shipment. Orders begin the shipping process as soon as your online purchase is complete. Items are shipped once they are located in stock, your payment is approved, and the receiving address is verified. Currently, we do not offer advanced sale or backorder options.
Shipping Methods and Costs
During the checkout process you will be prompted to choose the shipping option that best suits your preferred method of shipping. Shipping costs are determined by a combination of the shipping method you choose and the total value of your order. During checkout you will be able to view your total shipping charges prior to order completion. You will also have the ability to upgrade your shipping method for faster delivery.
*Business days are Monday-Friday, excluding federal holidays within the United States
Standard Shipping, (3-8 business days): FedEx SmartPost and USPS Priority Mail are used for all standard shipping orders. You can expect your order to arrive within 3-8 full business days.
- FedEx SmartPost to 48 Contiguous States: The FedEx SmartPost program allows us to quickly send your package from the dressbarn.com fulfillment center to your local post office. Once your package arrives at your post office, your local mail carrier will deliver the package to you or place the package in your Post Office Box.
- USPS Priority Mail to Alaska, Hawaii, US Territories, APO/FPO, and Puerto Rico:
The USPS Priority Mail program allows us to quickly send your package from the dressbarn.com fulfillment center to your delivery address.
FedEx Second Day, (2-3 business days): Items may be shipped via our Second Day service to most destinations in the United States. You can expect your order to arrive within 2-3 full business days. Orders placed before 12pm ET will be shipped out on the same day. We currently do not offer an expedited shipping option for P.O. Boxes, APO/FPO, US Territories, Puerto Rico, and some rural areas of the United States.
FedEx Next Day, (1-2 business days): Items may be shipped via our Next Day service to most destinations in the United States. You can expect your order to arrive within 1-2 full business day. Orders placed before 12pm ET will be shipped out on the same day. We currently do not offer an expedited shipping option for P.O. Boxes, APO/FPO, US Territories, Puerto Rico, and some rural areas of the United States. International shipping is not offered on dressbarn.com at this time.
Please reference below for shipping estimates:
*excludes major holidays
*excludes major holidays
Ship to Store
All items on dressbarn.com are available for ship to store. This convenient feature allows you to shop online and pick-up your purchase in-store!
How do I place a Ship to Store order?
- Place the item(s) in your bag and click the begin checkout link.
- Once in checkout, check the box labeled Ship order to my dressbarn location.
- Upon checking the ship to store option, you will be given the opportunity to search for the store using either the city and state or zip code.
- Your search results will include a list of eligible ship-to-store locations, click the select button for the store you would like to ship to. Only one store may be chosen per order. If no stores appear, select another zip code or close the window and choose to ship to an alternate shipping address (i.e. your home) during the checkout process.
Can I expedite my shipment to the store?
When items are shipped to a dressbarn store, they are eligible for standard shipping only. You can expect your order to arrive at the store within 3-8 full business days.
Can I track my shipment to the store?
Yes. Items are shipped using FedEx Ground. You will be provided with a tracking number in your shipment confirmation email.
When can I pick up my order at the store?
Once your Fedex tracking number shows that your package has been delivered, you may pick up the order at the designated dressbarn store. Please verify store hours. The items will be kept at the store for 30 days after delivery. After 30 days from delivery date, any unclaimed items will be returned to the warehouse and you will receive credit for the item(s).
What information do I need to pick up my order?
Please bring a copy of your order confirmation email when you visit the dressbarn store to pick up your order. This email contains all of the information needed to identify your order. You will also be asked to sign for your order when you pick it up.
For your protection, you may be asked for the following:
- Proper photo ID (a valid state-issued ID or drivers license)
- Credit card used to make your purchase (if applicable)
Can I have someone else pick up my order for me?
For your protection, the owner or authorized user of the credit card must be present to pick up the merchandise.
What do I do if I want to return my order?
When your order arrives and you can return or exchange it at the dressbarn store! If you would prefer to return your order to dressbarn.com, please visit ourreturns page. If you have any questions, please feel free to contact us