Lung Cancer Patients at High-Volume Centers Survive Longer

A new study published in the Journal of the National Cancer Institute has established that institutional volume can significantly influence survival in lung cancer patients receiving chemoradiation. Overall, the 2-year survival rate of patients treated at high-volume centers (HVCs) was over 10% more than that of patients treated at low-volume centers (LVCs).

The retrospective analysis evaluated the outcomes of nearly 500 patients with locally-advanced non-small cell lung cancer (LA-NSCLC) who were enrolled in the NRG Oncology RTOG 0617 trial at 180 institutions. Patients were randomly assigned to receive 60 Gy or 74 Gy radiotherapy (RT), along with carboplatin/paclitaxel, with or without cetuximab. Centers that accrued more than 3 patients in the trial were classified as HVCs. LVCs saw 195 patients participating in the trial (range 1 to 3 patients), while HVCs enrolled 300 (range 4 to 18).

The analysis found that patients treated at HVCs had significantly longer overall and progression-free survival (OS and PFS, respectively). Median OS at HVCs was 26.2 months, compared with 19.8 months at LVCs (HR, 0.70; 95% CI, 0.56-0.88; P = .002). Median PFS at HVCs was 11.4 months while at LVCs it was 9.7 months (HR, 0.80; 95% CI, 0.65-0.99, P = .04). The authors report in their paper that patients at HVCs had much lower adverse events (AEs), most likely because they had a lower esophageal dose as well as a lower heart dose, compared with patients at LVCs. Grade 5 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, they write.

This is significant, according to lead author Bree R. Eaton, MD, a radiation oncologist at the Winship Cancer Institute at Emory University. “It’s hard to say conclusively but the underlying hypothesis and belief is that at large volume centers, where physicians and care team are specialized in treating that specific type of malignancy, particularly in instances where treatment is life-saving or the risk for severe toxicity is high, that outcomes are better at high volume centers, as opposed to small community centers where the people there treat a variety of things,” Eaton told Reuters Health. “Radiation as a technology has advanced and is a lot more complex than it used to be. In general there’s a lot of nuances and subjectivity,” she added.

Commenting on the study, Henry Soo-Min Park, MD, MPH, of Yale University School of Medicine told Reuters that the fact that about 25% of the patients at HVCs survived for at least 5 years is a significant outcome. “This disease is difficult to control but is potentially curable in some patients following aggressive treatment,” Park said.

Reference

Eaton BR, Pugh SL, Bradley JD, et al. Institutional enrollment and survival among NSCLC patients receiving chemoradiation: NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617. J Natl Cancer Inst. 2016;108(9). pii: djw034. doi: 10.1093/jnci/djw034.