Institutional Enrollment and Survival Among NSCLC Patients Receiving Chemoradiation: NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617. Journal Article

Local Library Link: Find It @ Loyola

Authors: Eaton, BR; Pugh, SL; Bradley, JD; Masters, G; Kavadi, VS; Narayan, S; Nedzi, L; Robinson, C; Wynn, RB; Koprowski, C; Johnson, DW; Meng, J; Curran, WJ
Article Title: Institutional Enrollment and Survival Among NSCLC Patients Receiving Chemoradiation: NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617.
Abstract: BACKGROUND: The purpose of this analysis is to evaluate the effect of institutional accrual volume on clinical outcomes among patients receiving chemoradiation for locally advanced non-small cell lung cancer (LA-NSCLC) on a phase III trial. METHODS: Patients with LA-NSCLC were randomly assigned to 60?Gy or 74?Gy radiotherapy (RT) with concurrent carboplatin/paclitaxel +/- cetuximab on NRG Oncology RTOG 0617. Participating institutions were categorized as low-volume centers (LVCs) or high-volume centers (HVCs) according to the number of patients accrued (=3 vs?>?3). All statistical tests were two-sided. RESULTS: Range of accrual for LVCs (n?=?195) vs HVCs (n?=?300) was 1 to 3 vs 4 to 18 patients. Baseline characteristics were similar between the two cohorts. Treatment at a HVC was associated with statistically significantly longer overall survival (OS) and progression-free survival (PFS) compared with treatment at a LVC (median OS?=?26.2 vs 19.8 months; HR?=?0.70, 95% CI?=?0.56 to 0.88, P = .002; median PFS: 11.4 vs 9.7 months, HR?=?0.80, 95% CI?=?0.65-0.99, P = .04). Patients treated at HVCs were more often treated with intensity-modulated RT (54.0% vs 39.5%, P = .002), had a lower esophageal dose (mean = 26.1 vs 28.0?Gy, P = .03), and had a lower heart dose (median = V5?Gy 38.2% vs 54.1%, P = .006; V50?Gy 3.6% vs 7.3%, P .001). Grade 5 adverse events (AEs) (5.3% vs 9.2%, P = .09) and RT termination because of AEs (1.3% vs 4.1%, P = .07) were less common among patients treated at HVCs. HVC remained independently associated with longer OS (P = .03) when accounting for other factors. CONCLUSION: Treatment at institutions with higher clinical trial accrual volume is associated with longer OS among patients with LA-NSCLC participating in a phase III trial.
Journal Title: Journal of the National Cancer Institute
ISSN: 1460-2105; 0027-8874
Publisher: Unknown  
Date Published: 2016