Concurrent Chemoradiation Therapy at High-Volume Facilities Improves Survival for NSCLC
Patients treated with definitive concurrent chemotherapy and radiation therapy for stage III non–small cell lung cancer (NSCLC) have longer overall survival when treated by highly experienced facilities, whether or not they are academic or community cancer centers. Researchers from the Yale University School of Medicine published these findings in an article by Wang et al in the Journal of Thoracic Oncology.
NSCLC accounts for 85% of all lung cancer cases in the United States. Approximately one-quarter of NSCLC cases are diagnosed at stage III, with only 25% of those patients surviving at least 5 years. National Comprehensive Cancer Network guidelines support the use of definitive concurrent chemotherapy and radiation therapy as a standard-of-care treatment option for patients with locally advanced stage III NSCLC.
Researchers analyzed data from the National Cancer Database (NCDB) for patients who were treated with definitive concurrent chemotherapy and radiation therapy for stage III NSCLC diagnosed and clinically staged between 2004 and 2006. They sought to determine whether there was a relationship between treatments at facilities with expertise in treating a large number of concurrent chemotherapy and radiation therapy cases and improved overall survival as well as whether any patient characteristics were associated with treatment at high-volume facilities.
Study Findings
The results show that patients (n = 1,207) treated at facilities that handle 12 or greater cases of concurrent chemotherapy and radiation therapy per year had longer overall survival (19.7 vs 17.3 months, P = .02) compared with those treated at low-volume centers (n = 8,866). The decreased risk for death was significant (hazard ratio = 0.93; 95% CI = 0.87–0.99; P = .03) after adjusting for patient characteristics and whether or not the patient was treated at an academic or nonacademic center. Of note, patients treated at a high-volume center had a higher number of comorbidities, had more advanced lymph node involvement of their lung cancer, and were treated with more advanced radiation techniques.
The authors suggest that “improved multidisciplinary collaboration, more tumor-site specific specialists, higher rates of protocol compliance, and the ability to provide chemotherapy and radiation therapy at the same center may be contributing to the increased survival at high-volume facilities.” Henry S. Park, MD, MPH, senior author of the study, said, “Further research is needed to determine whether or not centralizing chemoradiotherapy at high-volume facilities will improve lung cancer survival while reducing complications and costs.”
Dr. Park is the corresponding author of the Journal of Thoracic Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
