Twice-Daily Radiation Boosts Lung Cancer QOL

A new analysis of patient-reported data from a lung cancer trial links twice-daily radiation to a better quality of life trajectory compared to once-daily treatment. The findings, published in the Journal of Thoracic Oncology, come from the NRG-LU005 study which accrued 544 patients with limited-stage small cell lung cancer.

According to the source report from NRG Oncology, the primary goal of the NRG-LU005 trial was to test adding the immunotherapy drug atezolizumab to standard chemoradiation. That addition did not improve overall survival. However, an exploratory analysis indicated a longer median overall survival for patients who received twice-daily radiation, though the radiation schedule itself was not randomized between patients.

Patient-Reported Outcomes Analysis

As a follow-up, researchers conducted a patient-reported outcomes (PRO) analysis to explore the impact of treatment on quality of life. The PRO analysis used validated instruments: FACT-TOI, EQ-5D-5L, and PROMIS-Fatigue. It focused on a cohort of trial participants who were alive and on-study at each assessment point. PRO compliance was high, exceeding 85% at baseline and stabilizing between 60% and 68% through 21 months after treatment ended. Healthier patients with better performance scores and lung function were more likely to complete the surveys.

FACT-TOI scores declined in both treatment arms during chemoradiation, as expected. They improved at 3 months and either remained stable or exceeded baseline levels from 6 to 21 months following treatment.

Comparing Radiation Schedules

The analysis suggested that approximately half of the patients who received twice-daily radiation experienced a more favorable quality of life trajectory over time than those receiving once-daily radiation. This was associated with less clinically meaningful decline in longer-term quality of life. The association remained in a multivariable analysis after adjusting for patient characteristics.

The source notes a crucial caveat. Because the assignment to twice-daily or once-daily radiation was not randomized in this trial, other factors may have contributed to the observed results. The quality of life findings align with the earlier incidental finding of longer median overall survival with the twice-daily schedule.

Treatment Arms and Decline

In the randomized part of the trial comparing chemoradiation with or without atezolizumab, fewer patients in the immunotherapy arm experienced a clinically meaningful decline in FACT-TOI at 21 months (25% versus 38%). The report states this observation is influenced by the fact that participants who completed the assessments tended to be healthier.

The study's quality of life chair was Dr. Benjamin Movsas, co-medical director of Henry Ford Cancer in Michigan. The full results are now published after being initially reported as a late-breaking abstract at the ASTRO 2025 Annual Meeting in San Francisco.