Timing of Thoracic Radiation Therapy With Chemotherapy in Limited-stage Small-cell Lung Cancer

Survey of US Radiation Oncologists on Current Practice Patterns

Matthew J. Farrell, Jehan B. Yahya, Catherine Degnin, Yiyi Chen, John Holland, Mark A. Henderson, Jerry Jaboin, Matthew M. Harkenrider, Charles Thomas, Timur Mitin

Research output: Contribution to journalArticle

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Abstract

In this survey of 309 radiation oncologists in the United States on how they treat limited-stage small-cell lung cancer, respondents strongly aligned with guidelines, which recommend early concurrent chemoradiotherapy. However, there was disagreement about whether starting thoracic radiotherapy with cycle 1 of chemotherapy improved survival, and over one-third of respondents treated based on pre-chemotherapy volume, which might add unnecessary toxicity. Introduction: For limited-stage small-cell lung cancer (LS-SCLC), National Comprehensive Cancer Network guidelines recommend that thoracic radiotherapy (TRT) be delivered concurrently with chemotherapy and early in the regimen, with cycle 1 or 2. Evidence is conflicting regarding the benefit of early timing of TRT. A Korean randomized trial did not see a survival difference between early (cycle 1) and late (cycle 3) TRT. Current United States (US) practice patterns are unknown. Materials and Methods: We surveyed US radiation oncologists using an institutional review board-approved online questionnaire. Questions covered treatment recommendations, self-rated knowledge of trials, and demographics. Results: We received 309 responses from radiation oncologists. Ninety-eight percent recommend concurrent chemoradiotherapy over sequential. Seventy-one percent recommend starting TRT in cycle 1 of chemotherapy, and 25% recommend starting in cycle 2. In actual practice, TRT is started most commonly in cycle 2 (48%) and cycle 1 (44%). One-half of respondents (54%) believe starting in cycle 1 improves survival compared with starting in cycle 3. Knowledge of the Korean trial was associated with flexibility in delaying TRT to cycle 2 or 3 (P = .02). Over one-third (38%) treat based on pre-chemotherapy volume. Conclusion: US radiation oncologists strongly align with National Comprehensive Cancer Network guidelines, which recommend early concurrent chemoradiotherapy. Nearly three-quarters of respondents prefer starting TRT with cycle 1 of chemotherapy. However, knowledge of a trial supporting a later start was associated with flexibility in delaying TRT. Treating based on pre-chemotherapy volume—endorsed by over one-third of respondents—may add unnecessary toxicity. This survey can inform development of future trials.

Original languageEnglish (US)
JournalClinical Lung Cancer
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Small Cell Lung Carcinoma
Radiotherapy
Thorax
Drug Therapy
Chemoradiotherapy
Guidelines
Radiation Oncologists
Surveys and Questionnaires
Research Ethics Committees
Neoplasms
Demography

Keywords

  • Chemoradiotherapy
  • Combined-modality therapy
  • Questionnaire
  • Radiotherapy
  • Target volume

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Timing of Thoracic Radiation Therapy With Chemotherapy in Limited-stage Small-cell Lung Cancer : Survey of US Radiation Oncologists on Current Practice Patterns. / Farrell, Matthew J.; Yahya, Jehan B.; Degnin, Catherine; Chen, Yiyi; Holland, John; Henderson, Mark A.; Jaboin, Jerry; Harkenrider, Matthew M.; Thomas, Charles; Mitin, Timur.

In: Clinical Lung Cancer, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Timing of Thoracic Radiation Therapy With Chemotherapy in Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Current Practice Patterns",
abstract = "In this survey of 309 radiation oncologists in the United States on how they treat limited-stage small-cell lung cancer, respondents strongly aligned with guidelines, which recommend early concurrent chemoradiotherapy. However, there was disagreement about whether starting thoracic radiotherapy with cycle 1 of chemotherapy improved survival, and over one-third of respondents treated based on pre-chemotherapy volume, which might add unnecessary toxicity. Introduction: For limited-stage small-cell lung cancer (LS-SCLC), National Comprehensive Cancer Network guidelines recommend that thoracic radiotherapy (TRT) be delivered concurrently with chemotherapy and early in the regimen, with cycle 1 or 2. Evidence is conflicting regarding the benefit of early timing of TRT. A Korean randomized trial did not see a survival difference between early (cycle 1) and late (cycle 3) TRT. Current United States (US) practice patterns are unknown. Materials and Methods: We surveyed US radiation oncologists using an institutional review board-approved online questionnaire. Questions covered treatment recommendations, self-rated knowledge of trials, and demographics. Results: We received 309 responses from radiation oncologists. Ninety-eight percent recommend concurrent chemoradiotherapy over sequential. Seventy-one percent recommend starting TRT in cycle 1 of chemotherapy, and 25{\%} recommend starting in cycle 2. In actual practice, TRT is started most commonly in cycle 2 (48{\%}) and cycle 1 (44{\%}). One-half of respondents (54{\%}) believe starting in cycle 1 improves survival compared with starting in cycle 3. Knowledge of the Korean trial was associated with flexibility in delaying TRT to cycle 2 or 3 (P = .02). Over one-third (38{\%}) treat based on pre-chemotherapy volume. Conclusion: US radiation oncologists strongly align with National Comprehensive Cancer Network guidelines, which recommend early concurrent chemoradiotherapy. Nearly three-quarters of respondents prefer starting TRT with cycle 1 of chemotherapy. However, knowledge of a trial supporting a later start was associated with flexibility in delaying TRT. Treating based on pre-chemotherapy volume—endorsed by over one-third of respondents—may add unnecessary toxicity. This survey can inform development of future trials.",
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