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J Natl Cancer Inst. 2016 May 19;108(9). pii: djw034. doi: 10.1093/jnci/djw034. Print 2016 Sep.

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

Author information

1
Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM) brupper@emory.edu.
2
Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM).

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.

PMID:
27206636
PMCID:
PMC6059090
DOI:
10.1093/jnci/djw034
[Indexed for MEDLINE]
Free PMC Article

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