Timing of Thoracic Radiation Therapy With Chemotherapy in Limited-stage Small-cell Lung Cancer: Survey of US Radiation Oncologists on Current Practice Patterns

• Published in: Clinical lung cancer Vol. 19; no. 6; pp. e815 - e821
• Main Authors: Farrell, Matthew J., Yahya, Jehan B., Degnin, Catherine, Chen, Yiyi, Holland, John M., Henderson, Mark A., Jaboin, Jerry J., Harkenrider, Matthew M., Thomas, Charles R., Mitin, Timur
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2018
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Small Cell - epidemiology; Carcinoma, Small Cell - therapy; Chemoradiotherapy; Combined Modality Therapy; Female; Humans; Lung Neoplasms - epidemiology; Lung Neoplasms - therapy; Male; Neoplasm Staging; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Questionnaire; Radiation Oncologists; Radiotherapy; Randomized Controlled Trials as Topic; Surveys and Questionnaires; Target volume; United States - epidemiology; United States; Combined-modality therapy; Questionnaire; Radiotherapy; Target volume; Chemoradiotherapy
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2018.04.007

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. 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. We surveyed US radiation oncologists using an institutional review board-approved online questionnaire. Questions covered treatment recommendations, self-rated knowledge of trials, and demographics. 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. 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.