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and multivariable survival outcomes were assessed. Result: In the cohort of 5877 patients, 2892 (49%) received chemoradiation, 1300 (22%) received surgery with radiation or chemotherapy, 639 (11%) received chemotherapy alone, 628 (11%) received surgery alone, and 418 (7%) received radiation alone. Amongst patients receiving surgery, 1277 (66%) received a lobectomy or pneumonectomy. Likelihood of receiving surgery in combination with radiation or chemotherapy was higher in later years of diagnosis (15% in 2006 vs 25% in 2014, p<0.001). Stage IA was more prevalent in the group that received surgery alone (77%) or surgery with chemotherapy or radiation (75%) compared to chemoradiation (45%), chemotherapy (49%), and radiation (63%). Median overall survival was most favorable for surgery with chemotherapy or radiation (51.8 months) followed by surgery alone (33.2 months) compared to chemotherapy + radiation (26.2 months), radiation alone (17.8 months), and chemotherapy alone (11.8 months)(p<0.001). In a multivariable Cox model (Table), surgery with chemotherapy and/or radiation was associated with decreased mortality versus chemoradiation (hazard ratio¼0.6, P<0.001). Conclusion: Utilization of surgery in localized SCLC remains low, despite its association with improved survival. Future clinical trials may be needed to establish the best therapeutic strategy for these patients.

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group, the median risk score based on the RSF model can significantly stratify patients into low-vs. high-risk groups for suffering disease progression (P<0.001, log-rank test). Using the same cutoff value, the RSF model was validated by the testing group (PZ 0.016,log-rank test). Conclusion: Integration of tumor and nodal imaging characteristics at pre and mid-treatment PET scans may allow better prediction of progression-free survival for local advanced NSCLC patients, and help to optimize radiation intensity or modify the therapeutic regimen.