TY - JOUR
T1 - Timing of Thoracic Radiation Therapy With Chemotherapy in Limited-stage Small-cell Lung Cancer
T2 - Survey of US Radiation Oncologists on Current Practice Patterns
AU - Farrell, Matthew J.
AU - Yahya, Jehan B.
AU - Degnin, Catherine
AU - Chen, Yiyi
AU - Holland, John M.
AU - Henderson, Mark A.
AU - Jaboin, Jerry J.
AU - Harkenrider, Matthew M.
AU - Thomas, Charles R.
AU - Mitin, Timur
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/11
Y1 - 2018/11
N2 - 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.
AB - 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.
KW - Chemoradiotherapy
KW - Combined-modality therapy
KW - Questionnaire
KW - Radiotherapy
KW - Target volume
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U2 - 10.1016/j.cllc.2018.04.007
DO - 10.1016/j.cllc.2018.04.007
M3 - Article
C2 - 29857969
AN - SCOPUS:85047522129
SN - 1525-7304
VL - 19
SP - e815-e821
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
IS - 6
ER -