{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T01:25:55Z","timestamp":1788139555237,"version":"build-2803163510"},"reference-count":13,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The impact of patient-specific, disease-related, and social factors on outcomes in limited-stage small cell lung cancer (LS-SCLC) is not well defined. A post hoc secondary analysis of such factors from the Cancer and Leukemia Group B (CALGB) 30610\u2013Radiation Therapy Oncology Group (RTOG) 0538 trial may impact future trial design.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the comprehensive demographic, disease-related, treatment-related, and social factors for potential associations with survival outcomes and understand whether specific subpopulations may benefit from radiotherapy (RT) dose escalation in LS-SCLC.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This post hoc secondary analysis of a randomized clinical trial included 638 adults with LS-SCLC treated at 186 unique treatment sites with at least 1 accrual for all patients from March 15, 2008, to December 1, 2019; 313 patients were randomized to receive RT twice daily to a dosage of 45 Gy for 3 weeks and 325 to receive RT once daily to a dosage of 70 Gy for 7 weeks. Data were locked February 28, 2022, and analyzed from November 28, 2022, to June 4, 2024.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Twice-daily RT or once-daily RT.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Multivariable Cox proportional hazards models evaluated the association of treatment groups and other risk factors with progression-free survival (PFS) and overall survival (OS). Patient-specific factors included age, sex, and Eastern Cooperative Oncology Group performance status. Disease-related factors included tumor, nodal, and overall cancer stages. Treatment-related factors included type of chemotherapy, timing of concurrent RT, RT technique, and prophylactic cranial irradiation. Social factors included marital status and treatment center accrual volume.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 507 patients (260 [51.3%] female and 247 [48.7%] male; mean [SD] age, 62.6 [7.9] years) included in the multivariate survival analysis, with a median follow-up of 4.7 (IQR, 3.7-7.1) years, female sex was associated with improved OS (hazard ratio [HR],\u20090.73 [95% CI, 0.58-0.91];\n P<\/jats:italic>\n \u2009=\u2009.006), while being 70 years or older was associated with decreased OS (HR,\u20091.50 [95% CI, 1.14-1.98];\n P<\/jats:italic>\n \u2009=\u2009.004). Neither age nor sex was associated with PFS. When compared with those with N1 disease, OS and PFS were worse in patients with N2 (HRs,\u20091.64 [95% CI, 1.19-2.26];\n P<\/jats:italic>\n \u2009=\u2009.002 and 1.36 [95% CI, 1.02-1.81];\n P<\/jats:italic>\n \u2009=\u2009.04, respectively) and N3 (HRs,\u20092.03 [95% CI, 1.40-2.93];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 and 1.63 [95% CI, 1.17-2.26];\n P<\/jats:italic>\n \u2009=\u2009.004) disease. Compared with stage II cancer, OS was worse for stage IIIA (HR,\u20091.65 [95% CI, 1.17-2.31];\n P<\/jats:italic>\n \u2009=\u2009.004) and stage IIIB (HR,\u20091.94 [95% CI, 1.34-2.83];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Compared with high-volume accrual centers, treatment at low- or middle-volume accrual centers was associated with worse PFS (HRs,\u20091.94 [95% CI, 1.33-2.82;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001] and 1.44 [95% CI, 1.15-1.82;\n P<\/jats:italic>\n \u2009=\u2009.002], respectively) and worse OS (HRs,\u20091.55 [95% CI, 1.03-2.32;\n P<\/jats:italic>\n \u2009=\u2009.03] and 1.33 [95% CI, 1.04-1.70;\n P<\/jats:italic>\n \u2009=\u2009.02], respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This secondary analysis of the CALGB 30610\u2013RTOG 0538 randomized clinical trial of patients with LS-SCLC found associations between female sex or being younger than 70 years and improved overall survival and between advanced nodal stage or treatment at low- or middle-volume accrual centers and worse outcomes. These findings suggest that stratification by nodal stage, clinical stage, and age should be considered in future randomized trials.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT00632853<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.40673","type":"journal-article","created":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T11:32:04Z","timestamp":1729769524000},"page":"e2440673","source":"Crossref","is-referenced-by-count":13,"title":["Prognostic Factors in Limited-Stage Small Cell Lung Cancer"],"prefix":"10.1001","volume":"7","author":[{"given":"Michael K.","family":"Farris","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Wake Forest Medical University, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Mix","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofei","family":"Wang","sequence":"additional","affiliation":[{"name":"Alliance Statistics and Data Management Center, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandy","family":"Jaszewski","sequence":"additional","affiliation":[{"name":"Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Foster","sequence":"additional","affiliation":[{"name":"Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A.","family":"Masters","sequence":"additional","affiliation":[{"name":"Helen F. Graham Cancer Center, Newark, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran","family":"Laurie","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koren","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niema B.","family":"Razavian","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Wake Forest Medical University, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan S.","family":"Alden","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritsuko","family":"Komaki","sequence":"additional","affiliation":[{"name":"University of Texas M. D. Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Stinchcombe","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Everett E.","family":"Vokes","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Bogart","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,10,24]]},"reference":[{"issue":"28","key":"zoi241177r1","doi-asserted-by":"publisher","first-page":"4539","DOI":"10.1200\/JCO.2005.04.4859","article-title":"Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database.","volume":"24","author":"Govindan","year":"2006","journal-title":"J Clin Oncol"},{"issue":"4","key":"zoi241177r2","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1056\/NEJM199901283400403","article-title":"Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide.","volume":"340","author":"Turrisi","year":"1999","journal-title":"N Engl J Med"},{"issue":"12","key":"zoi241177r3","doi-asserted-by":"publisher","first-page":"1770","DOI":"10.1097\/JTO.0000000000000672","article-title":"Utilization of hyperfractionated radiation in small-cell lung cancer and its impact on survival.","volume":"10","author":"Schreiber","year":"2015","journal-title":"J Thorac Oncol"},{"issue":"13","key":"zoi241177r4","doi-asserted-by":"publisher","first-page":"2394","DOI":"10.1200\/JCO.22.01359","article-title":"High-dose once-daily thoracic radiotherapy in limited-stage small-cell lung cancer: CALGB 30610 (Alliance)\/RTOG 0538.","volume":"41","author":"Bogart","year":"2023","journal-title":"J Clin Oncol"},{"issue":"8","key":"zoi241177r5","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1016\/S1470-2045(17)30318-2","article-title":"Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial.","volume":"18","author":"Faivre-Finn","year":"2017","journal-title":"Lancet Oncol"},{"issue":"3","key":"zoi241177r6","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/S1470-2045(20)30742-7","article-title":"High-dose versus standard-dose twice-daily thoracic radiotherapy for patients with limited stage small-cell lung cancer: an open-label, randomised, phase 2 trial.","volume":"22","author":"Gr\u00f8nberg","year":"2021","journal-title":"Lancet Oncol"},{"issue":"1","key":"zoi241177r7","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.jtho.2018.09.027","article-title":"Compliance and outcome of elderly patients treated in the Concurrent Once-Daily Versus Twice-Daily Radiotherapy (CONVERT) trial.","volume":"14","author":"Christodoulou","year":"2019","journal-title":"J Thorac Oncol"},{"issue":"3","key":"zoi241177r8","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.5335","article-title":"Association of chemoradiotherapy with outcomes among patients with stage I to II vs stage III small cell lung cancer: secondary analysis of a randomized clinical trial.","volume":"5","author":"Salem","year":"2019","journal-title":"JAMA Oncol"},{"issue":"7","key":"zoi241177r9","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1200\/JCO.19.01162","article-title":"Long-term results of NRG Oncology RTOG 0617: standard- versus high-dose chemoradiotherapy with or without cetuximab for unresectable stage III non\u2013small-cell lung cancer.","volume":"38","author":"Bradley","year":"2020","journal-title":"J Clin Oncol"},{"issue":"9","key":"zoi241177r10","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1093\/jnci\/djw034","article-title":"Institutional enrollment and survival among NSCLC patients receiving chemoradiation: NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617.","volume":"108","author":"Eaton","year":"2016","journal-title":"J Natl Cancer Inst"},{"key":"zoi241177r11","doi-asserted-by":"publisher","first-page":"e461","DOI":"10.14694\/EdBook_AM.2014.34.e461","article-title":"Tumor boards: optimizing the structure and improving efficiency of multidisciplinary management of patients with cancer worldwide.","author":"El Saghir","year":"2014","journal-title":"Am Soc Clin Oncol Educ Book"},{"issue":"11","key":"zoi241177r12","doi-asserted-by":"publisher","first-page":"2566","DOI":"10.1016\/j.acra.2023.01.019","article-title":"Bridging the communication gaps: a prospective single-arm pilot study testing the feasibility of interdisciplinary radiotherapy planning in locally advanced lung cancer.","volume":"30","author":"Farris","year":"2023","journal-title":"Acad Radiol"},{"issue":"4","key":"zoi241177r13","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1067\/j.cpradiol.2019.05.004","article-title":"Dedicated diagnostic radiology\/radiation oncology rounds: added value beyond traditional tumor boards.","volume":"49","author":"Kallianos","year":"2020","journal-title":"Curr Probl Diagn Radiol"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2825302\/farris_2024_oi_241177_1729184112.82879.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T11:32:05Z","timestamp":1729769525000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2825302"}},"subtitle":["A Secondary Analysis of CALGB 30610\u2013RTOG 0538"],"short-title":[],"issued":{"date-parts":[[2024,10,24]]},"references-count":13,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.40673","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,24]]}}}