Shaan Dudani1, Natasha B Leighl2, Cheryl Ho3, Jason R Pantarotto4, Xiaofu Zhu5, Tinghua Zhang6, Paul Wheatley-Price7. 1. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 2. Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. 3. Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. 4. Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 5. Division of Medical Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada. 6. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 7. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: pwheatleyprice@toh.on.ca.
Abstract
BACKGROUND AND OBJECTIVES: Standard management of stage II non-small cell lung cancer (NSCLC) is surgery, often followed by adjuvant chemotherapy. However, some patients do not undergo surgery for various reasons. The optimal non-surgical management of stage II NSCLC is undefined. We surveyed Canadian oncologists to understand current practices. MATERIALS AND METHODS: Canadian oncologists specializing in the management of lung cancer were invited by email to complete an anonymous, online survey developed by the research team. Physician demographics were recorded. Physicians were asked to comment on their practice and make treatment choices in eight clinical scenarios of inoperable stage II NSCLC. RESULTS: Responses were received from 81/194 physicians (42% response rate), 57% medical and 42% radiation oncologists. Most physicians (90%) had a practice with at least 25% lung cancer patients and 85% were based at an academic institution. Across eight clinical patient scenarios, radical therapy was selected 79-98% of the time. Radical radiotherapy alone and concurrent chemoradiotherapy were the preferred options for these patients, while sequential chemoradiation was less favoured. Nodal status (N0 vs N1) did not influence choice of therapy (p 0.31), but the reason for patient inoperability did (p<0.0001). There was no significant difference in choice of therapy when comparing responses between medical vs radiation oncologists, academic vs community physicians, and physicians with high vs low proportion of lung cancer patients. CONCLUSION: Most lung cancer physicians manage inoperable stage II NSCLC patients with curative intent, but consensus on how to optimally employ radiotherapy and/or chemotherapy is lacking. Future prospective, randomized trials are warranted.
BACKGROUND AND OBJECTIVES: Standard management of stage II non-small cell lung cancer (NSCLC) is surgery, often followed by adjuvant chemotherapy. However, some patients do not undergo surgery for various reasons. The optimal non-surgical management of stage II NSCLC is undefined. We surveyed Canadian oncologists to understand current practices. MATERIALS AND METHODS: Canadian oncologists specializing in the management of lung cancer were invited by email to complete an anonymous, online survey developed by the research team. Physician demographics were recorded. Physicians were asked to comment on their practice and make treatment choices in eight clinical scenarios of inoperable stage II NSCLC. RESULTS: Responses were received from 81/194 physicians (42% response rate), 57% medical and 42% radiation oncologists. Most physicians (90%) had a practice with at least 25% lung cancerpatients and 85% were based at an academic institution. Across eight clinical patient scenarios, radical therapy was selected 79-98% of the time. Radical radiotherapy alone and concurrent chemoradiotherapy were the preferred options for these patients, while sequential chemoradiation was less favoured. Nodal status (N0 vs N1) did not influence choice of therapy (p 0.31), but the reason for patient inoperability did (p<0.0001). There was no significant difference in choice of therapy when comparing responses between medical vs radiation oncologists, academic vs community physicians, and physicians with high vs low proportion of lung cancerpatients. CONCLUSION: Most lung cancer physicians manage inoperable stage II NSCLCpatients with curative intent, but consensus on how to optimally employ radiotherapy and/or chemotherapy is lacking. Future prospective, randomized trials are warranted.
Authors: Asha Bonney; Michael Christie; Anne Beaty; Sebastian Lunke; Graham Taylor; Louis Irving; Daniel Steinfort Journal: J Thorac Dis Date: 2016-09 Impact factor: 2.895