title: Institutional Enrollment and Survival Among NSCLC Patients Receiving Chemoradiation: NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 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.
authors.forename: Bree R
authors.initials: BR
authors.lastname: Eaton
authors.affiliation: 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).
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Pugh
authors.affiliation: 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).
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bradley
authors.affiliation: 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).
authors.forename: Greg
authors.initials: G
authors.lastname: Masters
authors.affiliation: 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).
authors.forename: Vivek S
authors.initials: VS
authors.lastname: Kavadi
authors.affiliation: 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).
authors.forename: Samir
authors.initials: S
authors.lastname: Narayan
authors.affiliation: 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).
authors.forename: Lucien
authors.initials: L
authors.lastname: Nedzi
authors.affiliation: 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).
authors.forename: Cliff
authors.initials: C
authors.lastname: Robinson
authors.affiliation: 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).
authors.forename: Raymond B
authors.initials: RB
authors.lastname: Wynn
authors.affiliation: 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).
authors.forename: Christopher
authors.initials: C
authors.lastname: Koprowski
authors.affiliation: 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).
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: 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).
authors.forename: Joanne
authors.initials: J
authors.lastname: Meng
authors.affiliation: 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).
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Curran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000628:therapy*; D000068818:Cetuximab / Q000008:administration & dosage; D018572:Disease-Free Survival; D004947:Esophagus; D005260:Female; D006321:Heart; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk; D017239:Paclitaxel / Q000008:administration & dosage; D018579:Patient Selection; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D015996:Survival Rate
chemical_list: D016190:Carboplatin; D017239:Paclitaxel; D000068818:Cetuximab