Originally published as JCO Early Release 10.1200/JCO.2003.04.018 on November 3 2003

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Radiotherapy Patterns of Care Study in Lung Carcinoma

B. Movsas, J. Moughan, R. Komaki, H. Choy, R. Byhardt, C. Langer, M. Goldberg, M. Graham, D. Ettinger, D. Johnstone, R. Abrams, R. Munden, G. Starkschall, J. Owen

From the Fox Chase Cancer Center; American College of Radiology, Philadelphia, PA; M.D. Anderson Cancer Center, Houston, TX; Vanderbilt University Medical Center, Nashville, TN; Medical College of Wisconsin, Milwaukee, WI; Phelps County Regional Medical Center, Rolla, MO; Johns Hopkins Hospital, Baltimore, MD; and University of Rochester, Rochester, NY.

Address reprint requests to Benjamin Movsas, MD, Fox Chase Cancer Center, 7701 Burholme Ave, Philadelphia, PA 19111; e-mail: b_movsas{at}fccc.edu.

Purpose: For the first time, a lung Patterns of Care Study was conducted to determine the national patterns of radiation (RT) practice in patients treated for nonmetastatic lung cancer in 1998 to 1999.

Materials and Methods: A national survey of randomly selected RT institutions in the United States was conducted using two-stage cluster sampling, stratified by practice type. Patients with nonmetastatic lung cancer (Karnofsky performance score [KPS] 60), who received RT as definitive or adjuvant therapy, were randomly selected. To determine national estimates, sample size was weighted by the relative number of institutions per strata and the number of patient records reviewed per the number of patients eligible. Accordingly, 42,335 patient records from 58 institutions were reviewed by trained research associates. The unweighted sample size (or number of patients) was 541.

Results: The histologies were small-cell lung cancer (SCLC) in 14.5% of patients versus non–small-cell lung cancer (NSCLC) in 85.5% of patients. The median age was 67 years (range, 29 to 92 years); 61% of patients were male, and 38% were current smokers. Bone scans and brain imaging were not obtained in 34% and 52% of clinical stage (CS) III NSCLC patients, respectively. Regarding treatment strategies, for SCLC and CS III NSCLC, chemotherapy plus RT was used significantly more than RT alone (P < .05); in CS I NSCLC, RT alone was the primary treatment (P < .05). Overall, 58% of patients received systemic therapy. On multivariate analysis, factors correlating with increased use of chemotherapy included younger age, histology (SCLC > NSCLC), increasing CS, increasing KPS, and lack of comorbidities. Only 3% of all patients were treated on prospective clinical trials.

Conclusion: This study establishes the general patterns of care for lung carcinoma in RT facilities within the United States. As supported by clinical trials, patients with limited-stage SCLC and CS III NSCLC received chemotherapy plus RT more than they received RT alone. Further improvements in staging, smoking cessation, and increased accrual to clinical trials must be encouraged.

Supported by grant no. CA 65435 from the National Cancer Institute, National Institutes of Health, Bethesda, MD.

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