Abstract
Background
Thoracic radiotherapy (TRT) with concurrent chemotherapy is standard for limited-stage
small-cell lung cancer (LS-SCLC). However, the optimal dosing and fractionation remain
unclear. The National Comprehensive Cancer Network guidelines have recommended either
45 Gy delivered twice daily (BID) or 60 to 70 Gy delivered once daily (QD). However,
the current practice patterns among US radiation oncologists are unknown.
Materials and Methods
We surveyed US radiation oncologists using an institutional review board-approved
questionnaire. The questions covered demographic data, self-rated knowledge of key
trials, and treatment recommendations.
Results
We received 309 responses from radiation oncologists. Of the 309 radiation oncologists,
60% preferred TRT QD and 76% acknowledged QD to be more common in their practice.
The respondents in academic settings were more likely to endorse BID treatment by
both preference (P = .001) and actual practice (P = .009). The concordance between preferring QD and administering QD in practice was
100%. In contrast, 40% of respondents who preferred BID actually administered QD more
often. Also, 15% of physicians would be unwilling to switch from QD to BID and 3%
would be unwilling to switch from BID to QD, even on patient request. Most respondents
(88%) recommended a dose of 45 Gy for BID treatment. For QD treatment, the division
was greater, with 54% recommending 60 Gy, 30% recommending 63 to 66 Gy, and 10% recommending
70 Gy.
Conclusion
Substantial variation exists in how US radiation oncologists approach TRT dosing and
fractionation for LS-SCLC. Three quarters of our respondents reported administering
TRT QD most often. The most common doses were 60 Gy QD and 45 Gy BID. The results
of the present survey have provided the most up-to-date information on US practice
patterns for LS-SCLC.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Lung CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Howlader N, Noone AM, Krapcho M, et al, eds. SEER cancer statistics review, 1975-2014. April 2017, based on November 2016 SEER data submission. Available at: https://seer.cancer.gov/csr/1975_2014/. Accessed: March 13, 2018.
- National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer (Version 2.2018).(Available at:) (Accessed: March 13, 2018)
- Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide.N Engl J Med. 1999; 340: 265-271
- Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial.Lancet Oncol. 2017; 18: 1116-1125
- Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group.N Engl J Med. 1999; 341: 476-484
- Patterns of failure after prophylactic cranial irradiation in small-cell lung cancer: analysis of 505 randomized patients.Ann Oncol. 2002; 13: 748-754
- A meta-analysis of thoracic radiotherapy for small-cell lung cancer.N Engl J Med. 1992; 327: 1618-1624
- Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis.J Clin Oncol. 1992; 10: 890-895
- Trends in the outcomes for patients with limited stage small cell lung cancer: an analysis of the Surveillance, Epidemiology, and End Results database.Lung Cancer. 2009; 64: 226-231
- What is the optimal radiotherapy schedule for limited stage small cell lung cancer?.Lung Cancer. 2017; 105: 52-53
- National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer (Version 2.2017).(Available at:) (Accessed: November 2, 2016)
- Utilization of hyperfractionated radiation in small-cell lung cancer and its impact on survival.J Thorac Oncol. 2015; 10: 1770-1775
- Phase I study to determine the maximum-tolerated dose of radiation in standard daily and hyperfractionated-accelerated twice-daily radiation schedules with concurrent chemotherapy for limited-stage small-cell lung cancer.J Clin Oncol. 1998; 16: 3528-3536
- 70 Gy thoracic radiotherapy is feasible concurrent with chemotherapy for limited-stage small-cell lung cancer: analysis of Cancer and Leukemia Group B study 39808.Int J Radiat Oncol Biol Phys. 2004; 59: 460-468
- Phase II study of accelerated high-dose radiotherapy with concurrent chemotherapy for patients with limited small-cell lung cancer: Radiation Therapy Oncology Group protocol 0239.Int J Radiat Oncol Biol Phys. 2012; 83: e531-e536
- The State of Cancer Care in America, 2017: A Report by the American Society of Clinical Oncology.J Oncol Pract. 2017; 13: e353-e394
Faivre-Finn C, Snee M, Ashcroft L, et al. Concurrent once-daily versus twice-daily radiotherapy: an international 2-arm randomized controlled trial of concurrent chemoradiotherapy comparing twice-daily and once-daily radiotherapy schedules in patients with limited stage small cell lung cancer (LS-SCLC) and good performance status. Presented at the 2016 American Society of Clinical Oncology Annual Meeting, Chicago, IL, June 3-7. Abstract 8504.
- Penetration of recommended procedures for lung cancer staging and management in the United States over 10 years: a quality research in radiation oncology survey.Int J Radiat Oncol Biol Phys. 2013; 85: 1082-1089
- An assessment of the current US radiation oncology workforce: methodology and global results of the American Society for Radiation Oncology 2012 Workforce Study.Int J Radiat Oncol Biol Phys. 2013; 87: 1129-1134
- Practice patterns for the prophylaxis and treatment of acute radiation dermatitis in the United States.Support Care Cancer. 2017; 25: 2857-2862
- Find radiation oncologists.(Available at:) (Accessed: February 9, 2018)
Article info
Publication history
Published online: August 22, 2018
Accepted:
August 11,
2018
Received in revised form:
July 24,
2018
Received:
May 6,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
