Twice-Daily Radiation Tied to Better Quality-of-Life Trend in Lung Cancer Trial

The NRG Oncology/Alliance LU005 trial (NCT03811002) tested adding the immunotherapy drug atezolizumab (Tecentriq) to standard concurrent chemoradiation for limited-stage small-cell lung cancer. Primary results, reported at the American Society for Radiation Oncology (ASTRO) 2024 Annual Meeting, showed that atezolizumab did not improve overall survival (OS). An exploratory analysis also found longer median OS among patients who received twice-daily radiation therapy (RT), though the RT schedule was not randomized.

A follow-up patient-reported outcomes (PRO) analysis, first presented as a late-breaking abstract at ASTRO's 2025 Annual Meeting in San Francisco, is now published in the Journal of Thoracic Oncology. The trial accrued and randomized 544 patients receiving standard chemoradiation with thoracic RT — either 45 Gy twice daily or 66 Gy once daily — to receive or not receive concurrent and adjuvant immunotherapy. Quality of life (QOL) was tracked using validated tools — FACT-TOI, EQ-5D-5L and PROMIS-Fatigue — measuring clinically meaningful decline (CMD) and trends over time. PRO survey compliance was high, exceeding 85% at baseline and stabilizing at 60%-68% through 21 months after chemoradiation, though healthier patients were more likely to complete the surveys.

FACT-TOI scores declined in both arms during chemoradiation, as expected, then improved at 3 months and stayed stable or exceeded baseline from 6 to 21 months afterward. Fewer patients in the immunotherapy arm had CMD in FACT-TOI at 21 months than those without immunotherapy (25% vs. 38%), though researchers noted this is influenced by patients who completed the assessments tending to be healthier.

About half the patients received twice-daily radiation, which was associated with a more favorable QOL trajectory over time than once-daily radiation. This association persisted in a multivariable analysis adjusting for patient characteristics, but because the RT schedule was not randomized, other factors may have contributed to the result.

The QOL chair of NRG-LU005 was Dr. Benjamin Movsas, co-medical director of Henry Ford Cancer in Michigan and co-chair of the Henry Ford Health + Michigan State University Health Sciences Cancer Committee. The findings were published by Benjamin Movsas et al. in the Journal of Thoracic Oncology (2026).