Practice Patterns of Thoracic Radiotherapy for Extensive-Stage Small-Cell Lung Cancer: Survey of US Academic Thoracic Radiation Oncologists

Carl M. Post, Vivek Verma, Timur Mitin, Charles B. Simone

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Despite the recent CREST trial demonstrating a survival benefit to thoracic radiotherapy (TRT) for patients with extensive-stage small-cell lung cancer (ES-SCLC) with response to chemotherapy, as well as endorsement by current National Comprehensive Cancer Network guidelines, TRT may not be uniformly delivered in clinical practice across all circumstances. Methods and Materials: We surveyed US academic thoracic radiation oncologists regarding their practice patterns for TRT and assessed conditions in which withholding TRT could be warranted. A 27-question survey of demographics and practice patterns, including 5 clinical cases, was sent to 111 physicians. Results: Response rate was 39% (43/111). Among respondents, 60% have at least 6 years of work experience following residency; 77% and 71% respectively see > 50 lung cancer and > 11 SCLC cases annually. Regarding practice patterns, 74% use TRT in 26% to 75% of patients with ES-SCLC. Respondents would withhold TRT in cases with Eastern Cooperative Oncology Group performance status ≥ 3 (91%), when pulmonary function necessitates continuous oxygen via nasal cannula (62%), for postchemotherapy tumor progression (58%), and if > 4 postchemotherapy extrathoracic metastases were present (58%). The 5 clinical cases highlighted practice variability, although 1 case had 100% agreement among respondents. Conclusions: Despite support of TRT administration from the CREST trial, there are several conditions associated with frequently withholding TRT. The most common reasons include performance status, postchemotherapy extent of disease, and pulmonary function; age and prechemotherapy extent of disease were least associated. Further research should aim to identify which subgroups of ES-SCLC benefit most from TRT.

Original languageEnglish (US)
JournalClinical Lung Cancer
DOIs
StateAccepted/In press - Sep 25 2016

Fingerprint

Small Cell Lung Carcinoma
Radiotherapy
Thorax
Surveys and Questionnaires
Radiation Oncologists
Internship and Residency
Lung Diseases
Lung Neoplasms
Neoplasms
Demography
Guidelines
Oxygen
Neoplasm Metastasis
Physicians
Drug Therapy
Lung
Survival

Keywords

  • Chemotherapy
  • Consolidation
  • Performance status
  • Questionnaire
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Practice Patterns of Thoracic Radiotherapy for Extensive-Stage Small-Cell Lung Cancer : Survey of US Academic Thoracic Radiation Oncologists. / Post, Carl M.; Verma, Vivek; Mitin, Timur; Simone, Charles B.

In: Clinical Lung Cancer, 25.09.2016.

Research output: Contribution to journalArticle

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abstract = "Purpose: Despite the recent CREST trial demonstrating a survival benefit to thoracic radiotherapy (TRT) for patients with extensive-stage small-cell lung cancer (ES-SCLC) with response to chemotherapy, as well as endorsement by current National Comprehensive Cancer Network guidelines, TRT may not be uniformly delivered in clinical practice across all circumstances. Methods and Materials: We surveyed US academic thoracic radiation oncologists regarding their practice patterns for TRT and assessed conditions in which withholding TRT could be warranted. A 27-question survey of demographics and practice patterns, including 5 clinical cases, was sent to 111 physicians. Results: Response rate was 39{\%} (43/111). Among respondents, 60{\%} have at least 6 years of work experience following residency; 77{\%} and 71{\%} respectively see > 50 lung cancer and > 11 SCLC cases annually. Regarding practice patterns, 74{\%} use TRT in 26{\%} to 75{\%} of patients with ES-SCLC. Respondents would withhold TRT in cases with Eastern Cooperative Oncology Group performance status ≥ 3 (91{\%}), when pulmonary function necessitates continuous oxygen via nasal cannula (62{\%}), for postchemotherapy tumor progression (58{\%}), and if > 4 postchemotherapy extrathoracic metastases were present (58{\%}). The 5 clinical cases highlighted practice variability, although 1 case had 100{\%} agreement among respondents. Conclusions: Despite support of TRT administration from the CREST trial, there are several conditions associated with frequently withholding TRT. The most common reasons include performance status, postchemotherapy extent of disease, and pulmonary function; age and prechemotherapy extent of disease were least associated. Further research should aim to identify which subgroups of ES-SCLC benefit most from TRT.",
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N2 - Purpose: Despite the recent CREST trial demonstrating a survival benefit to thoracic radiotherapy (TRT) for patients with extensive-stage small-cell lung cancer (ES-SCLC) with response to chemotherapy, as well as endorsement by current National Comprehensive Cancer Network guidelines, TRT may not be uniformly delivered in clinical practice across all circumstances. Methods and Materials: We surveyed US academic thoracic radiation oncologists regarding their practice patterns for TRT and assessed conditions in which withholding TRT could be warranted. A 27-question survey of demographics and practice patterns, including 5 clinical cases, was sent to 111 physicians. Results: Response rate was 39% (43/111). Among respondents, 60% have at least 6 years of work experience following residency; 77% and 71% respectively see > 50 lung cancer and > 11 SCLC cases annually. Regarding practice patterns, 74% use TRT in 26% to 75% of patients with ES-SCLC. Respondents would withhold TRT in cases with Eastern Cooperative Oncology Group performance status ≥ 3 (91%), when pulmonary function necessitates continuous oxygen via nasal cannula (62%), for postchemotherapy tumor progression (58%), and if > 4 postchemotherapy extrathoracic metastases were present (58%). The 5 clinical cases highlighted practice variability, although 1 case had 100% agreement among respondents. Conclusions: Despite support of TRT administration from the CREST trial, there are several conditions associated with frequently withholding TRT. The most common reasons include performance status, postchemotherapy extent of disease, and pulmonary function; age and prechemotherapy extent of disease were least associated. Further research should aim to identify which subgroups of ES-SCLC benefit most from TRT.

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