Institutional Enrollment and Survival among NSCLC Patients Receiving Chemoradiation

NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617

Bree R. Eaton, Stephanie L. Pugh, Jeffrey D. Bradley, Greg Masters, Vivek S. Kavadi, Samir Narayan, Lucien Nedzi, Cliff Robinson, Raymond B. Wynn, Christopher Koprowski, Douglas W. Johnson, Joanne Meng, Walter J. Curran

Research output: Contribution to journalArticle

37 Citations (Scopus)

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.

Original languageEnglish (US)
Article numberdjw034
JournalJournal of the National Cancer Institute
Volume108
Issue number9
DOIs
StatePublished - Sep 1 2016

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Radiation Oncology
Radiotherapy
Survival
Non-Small Cell Lung Carcinoma
Disease-Free Survival
Intensity-Modulated Radiotherapy
Carboplatin
Paclitaxel
Therapeutics
Clinical Trials

ASJC Scopus subject areas

  • Medicine(all)
  • Oncology
  • Cancer Research

Cite this

Institutional Enrollment and Survival among NSCLC Patients Receiving Chemoradiation : NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617. / Eaton, Bree R.; Pugh, Stephanie L.; Bradley, Jeffrey D.; Masters, Greg; Kavadi, Vivek S.; Narayan, Samir; Nedzi, Lucien; Robinson, Cliff; Wynn, Raymond B.; Koprowski, Christopher; Johnson, Douglas W.; Meng, Joanne; Curran, Walter J.

In: Journal of the National Cancer Institute, Vol. 108, No. 9, djw034, 01.09.2016.

Research output: Contribution to journalArticle

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 2016, 'Institutional Enrollment and Survival among NSCLC Patients Receiving Chemoradiation: NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617', Journal of the National Cancer Institute, vol. 108, no. 9, djw034. https://doi.org/10.1093/jnci/djw034
Eaton, Bree R. ; Pugh, Stephanie L. ; Bradley, Jeffrey D. ; Masters, Greg ; Kavadi, Vivek S. ; Narayan, Samir ; Nedzi, Lucien ; Robinson, Cliff ; Wynn, Raymond B. ; Koprowski, Christopher ; Johnson, Douglas W. ; Meng, Joanne ; Curran, Walter J. / Institutional Enrollment and Survival among NSCLC Patients Receiving Chemoradiation : NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617. In: Journal of the National Cancer Institute. 2016 ; Vol. 108, No. 9.
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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.",
author = "Eaton, {Bree R.} and Pugh, {Stephanie L.} and Bradley, {Jeffrey D.} and Greg Masters and Kavadi, {Vivek S.} and Samir Narayan and Lucien Nedzi and Cliff Robinson and Wynn, {Raymond B.} and Christopher Koprowski and Johnson, {Douglas W.} and Joanne Meng and Curran, {Walter J.}",
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T1 - Institutional Enrollment and Survival among NSCLC Patients Receiving Chemoradiation

T2 - NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617

AU - Eaton, Bree R.

AU - Pugh, Stephanie L.

AU - Bradley, Jeffrey D.

AU - Masters, Greg

AU - Kavadi, Vivek S.

AU - Narayan, Samir

AU - Nedzi, Lucien

AU - Robinson, Cliff

AU - Wynn, Raymond B.

AU - Koprowski, Christopher

AU - Johnson, Douglas W.

AU - Meng, Joanne

AU - Curran, Walter J.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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.

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