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

Research paper by Carl M. Post, Vivek Verma; Timur Mitin; Charles B. Simone

Indexed on: 05 Jan '17Published on: 26 Dec '16Published in: Clinical Lung Cancer



Abstract

Publication date: Available online 22 December 2016 Source:Clinical Lung Cancer Author(s): Carl M. Post, Vivek Verma, Timur Mitin, Charles B. Simone Purpose Despite the recent CREST trial demonstrating a survival benefit to thoracic radiotherapy (TRT) for extensive-stage small cell lung cancer patients with response to chemotherapy, as well as endorsement by current NCCN guidelines, TRT may not be uniformly delivered in clinical practice across all circumstances. Methods and Materials We surveyed United States 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 26-75% of ES-SCLC patients. Respondents would withhold TRT in cases with ECOG PS ≥3 (91%), when pulmonary function necessitates continuous oxygen via nasal cannula (62%), for post-chemotherapy tumor progression (58%), and if >4 post-chemotherapy extrathoracic metastases were present (58%). The 5 clinical cases highlighted practice variability, although one 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, post-chemotherapy extent of disease, and pulmonary function; age and pre-chemotherapy extent of disease were least associated. Further research should aim to identify which subgroups of ES-SCLC benefit most from TRT.