Luca F Valle1, Reshma Jagsi2, Sarah N Bobiak3, Carrie Zornosa3, Thomas A D'Amico4, Katherine M Pisters5, Elisabeth U Dexter6, Joyce C Niland7, James A Hayman2, Nirav S Kapadia8. 1. Geisel School of Medicine at Dartmouth College, Dartmouth College, Hanover, New Hampshire. 2. Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. 3. National Comprehensive Cancer Network, Fort Washington, Pennsylvania. 4. Department of Surgery, Division of Thoracic Surgery, Duke Cancer Institute, Durham, North Carolina. 5. Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York. 7. Department of Information Sciences, City of Hope Comprehensive Cancer Center, Duarte, California. 8. Department of Radiation Oncology, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire. Electronic address: Nirav.S.Kapadia@hitchcock.org.
Abstract
PURPOSE: This study determined practice patterns in the staging and treatment of patients with stage I non-small cell lung cancer (NSCLC) among National Comprehensive Cancer Network (NCCN) member institutions. Secondary aims were to determine trends in the use of definitive therapy, predictors of treatment type, and acute adverse events associated with primary modalities of treatment. METHODS AND MATERIALS: Data from the National Comprehensive Cancer Network Oncology Outcomes Database from 2007 to 2011 for US patients with stage I NSCLC were used. Main outcome measures included patterns of care, predictors of treatment, acute morbidity, and acute mortality. RESULTS: Seventy-nine percent of patients received surgery, 16% received definitive radiation therapy (RT), and 3% were not treated. Seventy-four percent of the RT patients received stereotactic body RT (SBRT), and the remainder received nonstereotactic RT (NSRT). Among participating NCCN member institutions, the number of surgeries-to-RT course ratios varied between 1.6 and 34.7 (P<.01), and the SBRT-to-NSRT ratio varied between 0 and 13 (P=.01). Significant variations were also observed in staging practices, with brain imaging 0.33 (0.25-0.43) times as likely and mediastinoscopy 31.26 (21.84-44.76) times more likely for surgical patients than for RT patients. Toxicity rates for surgical and for SBRT patients were similar, although the rates were double for NSRT patients. CONCLUSIONS: The variations in treatment observed among NCCN institutions reflects the lack of level I evidence directing the use of surgery or SBRT for stage I NSCLC. In this setting, research of patient and physician preferences may help to guide future decision making.
PURPOSE: This study determined practice patterns in the staging and treatment of patients with stage I non-small cell lung cancer (NSCLC) among National Comprehensive Cancer Network (NCCN) member institutions. Secondary aims were to determine trends in the use of definitive therapy, predictors of treatment type, and acute adverse events associated with primary modalities of treatment. METHODS AND MATERIALS: Data from the National Comprehensive Cancer Network Oncology Outcomes Database from 2007 to 2011 for US patients with stage I NSCLC were used. Main outcome measures included patterns of care, predictors of treatment, acute morbidity, and acute mortality. RESULTS: Seventy-nine percent of patients received surgery, 16% received definitive radiation therapy (RT), and 3% were not treated. Seventy-four percent of the RT patients received stereotactic body RT (SBRT), and the remainder received nonstereotactic RT (NSRT). Among participating NCCN member institutions, the number of surgeries-to-RT course ratios varied between 1.6 and 34.7 (P<.01), and the SBRT-to-NSRT ratio varied between 0 and 13 (P=.01). Significant variations were also observed in staging practices, with brain imaging 0.33 (0.25-0.43) times as likely and mediastinoscopy 31.26 (21.84-44.76) times more likely for surgical patients than for RT patients. Toxicity rates for surgical and for SBRT patients were similar, although the rates were double for NSRT patients. CONCLUSIONS: The variations in treatment observed among NCCN institutions reflects the lack of level I evidence directing the use of surgery or SBRT for stage I NSCLC. In this setting, research of patient and physician preferences may help to guide future decision making.
Authors: Nirav S Kapadia; Luca F Valle; Julie A George; Reshma Jagsi; Thomas A D'Amico; Elisabeth U Dexter; Fawn D Vigneau; Feng Ming Kong Journal: Ann Thorac Surg Date: 2017-10-26 Impact factor: 4.330
Authors: Alessandra Buja; Giulia Pasello; Marco Schiavon; Giuseppe De Luca; Michele Rivera; Claudia Cozzolino; Anna De Polo; Manuela Scioni; Alberto Bortolami; Vincenzo Baldo; PierFranco Conte Journal: Thorac Cancer Date: 2022-08-15 Impact factor: 3.223
Authors: Alessandra Buja; Michele Rivera; Anna De Polo; Eugenio di Brino; Marco Marchetti; Manuela Scioni; Giulia Pasello; Alberto Bortolami; Vincenzo Rebba; Marco Schiavon; Fiorella Calabrese; Giovanni Mandoliti; Vincenzo Baldo; PierFranco Conte Journal: Thorac Cancer Date: 2020-11-21 Impact factor: 3.500