Radiotherapy (RT) Patterns of Care Study (PCS) in Lung Carcinoma

Reviewer: William Levin, MD
OncoLink
Last Modified: October 9, 2002

Presenter: B. Movsas
Presenter's Affiliation: Fox Chase Cancer Center (FCCC), Phila, PA, USA
Type of Session: Scientific

Background

This study was designed to determine the national patterns of radiation therapy (RT) practice in patients treated for non-metastatic lung cancer between 1998-1999.

Materials and Methods

A survey of randomly selected RT institutions was conducted. Both academic and non-academic institutions were surveyed.
Patients with non-metastatic lung cancer who received RT as definitive or adjuvant therapy were randomly selected.
The charts of 541 patients were reviewed.
58 institutions were represented.

Results

14.5% of histologies were small cell lung cancer (SCLC), while the remainder were non-small cell lung cancer (NSCLC).
Median age was 67 years (37-92).
58% of patients were male, while 42% were female.
32% of patients were current smokers.
59% of patients had co-morbidities, mostly cardiopulmonary.
KPS was >80 in 84% of patients.
98% of patients had staging CT scans.
In CS III patients, bone scans and brain MRI's were not obtained in 33% and 52%, respectively.
For NSCLC, a breakdown by clinical stage (CS) is as follows: CS I-12%, CS II-16%, CS III-54% (4% unknown).
For patients with NSCLC, 31% had their mediastinums pathologically staged.
Treatment strategies varied significantly by histology and stage.
The majority of patients with SCLC and stage III NSCLCA received chemotherapy (CT) + RT.
Most patients with CS I NSCLC received RT as their only treatment.
Median dose for RT in the SCLC patients was 51 Gy, 80% at 1.8-2 Gy/fraction; 10% received hyperfractionated (b.i.d.) RT.
23% of these patients received prophylactic cranial irradiation (median dose, 30 Gy/15 fractions).
For NSCLC, the median dose was 60 Gy, 85% @ 1.8-2 Gy/fraction.
The majority of patients were treated with 6MV or 10 MV photons.
CT-based treatment planning was used in 50% of patients.
Maximum spinal cord dose was 41 Gy, although the dose was unknown in 29%.
57% of patients received systemic treatment.
Surgery was performed in 28% of NSCLC patients.
5% of all patients were enrolled on cooperative trials, and 2% on institutional (IRB-approved) trials.

Author's Conclusions

This study establishes the general patterns of care for lung cancer in U.S. RT facilities.
Better staging and documentation of spinal cord dose should be encouraged.

Clinical/Scientific Implications

The authors point out recent studies supporting the use of PCI and b.i.d. RT in SCLC have not had enough time to fully be reflected in a patterns of care study.
Also, this study reveals that a small percentage of lung cancer patients are being enrolled on clinical trials.

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