Utilization of Hyperfractionated Radiation in Small-Cell Lung XXXX and Its Impact on Survival.

@entity1 @entity5 @entity5353 @entity4207 @entity151
INTRODUCTION: Twice-daily radiation with concurrent chemotherapy is recognized as the standard of care for the treatment of limited stage @entity151 ( @entity151 ), but its utilization in this setting is unclear. The objective of this study was to analyze modern patterns of treatment for limited stage @entity151 and the impact on survival utilizing the National @entity5 Database. METHODS: Between 1999 and 2012, there were 25,045 @entity1 diagnosed with nonmetastatic @entity151 who met the selection criteria, of whom 22,626 had survival data. Those receiving 45 Gy in 1.5 Gy fractions twice-daily ( @entity5353 ) were compared with those receiving 45 to 72 Gy in 1.8 or 2.0 Gy fractions. Overall survival was analyzed via Kaplan-Meier analysis and compared using the log-rank test. Multivariate Cox regression analysis was used to identify covariates associated with survival. RESULTS: The utilization of @entity5353 radiation overall was 11.3%. Treatment at an @entity4207 center was associated with a higher likelihood of receiving @entity5353 treatment (odds ratio: 2.29, 95% confidence interval [CI]: 1.95-2.69; p < 0.001). Median survival was 22.1, 17.2, 18.3, 19.2, and 19.5 months for @entity1 receiving 45 Gy @entity5353 , 45 Gy once-daily, 46 to 59.4 Gy once-daily, 60 to 61.2 Gy once-daily, and 62 to 72 Gy once-daily, respectively (p < 0.001 for all pairwise comparisons to @entity5353 ). On multivariate analysis, treatment at an @entity4207 center (hazard ratio: 0.88, 95% CI: 0.83-0.93; p < 0.001) and receipt of @entity5353 radiation (hazard ratio: 0.92, 95% CI: 0.86-0.98; p = 0.008) were associated with improved survival. CONCLUSIONS: The adoption of @entity5353 radiation remains very limited, but is more commonly utilized in the @entity4207 setting. In this hospital-based study, @entity5353 fractionation was associated with improved survival over once-daily fractionation, even at doses >= 60 Gy.
