Radiotherapy patterns of care for stage I and II non‐small cell lung cancer in Sydney, Australia

Abstract

Introduction: Curative radiotherapy is guideline treatment for inoperable patients of good performance status with Stage I & II Non-Small Cell Lung Cancer (NSCLC). The aim of this study was to evaluate radiotherapy patterns of care in these patients, the reasons for palliative treatment and the proportion of patients suitable for curative stereotactic ablative body radiotherapy (SABR). Methods: Electronic oncology databases at three institutions were queried to retrieve data on patients with inoperable Stage I & II NSCLC seen in radiation oncology clinics between 1/1/2008 and 31/12/2014. Suitability for SABR was defined as peripheral tumours less than 5 cm in size. Factors associated with curative treatment were determined using univariate and multivariate analyses. Results: Three-hundred-and-twelve patients were identified of whom 178 (57%) received curative radiotherapy, 58 (19%) palliative radiotherapy and 76 (24%) no radiotherapy. The main reason for receiving palliative rather than curative treatment was COPD or poor pulmonary function (26%). Method of diagnosis (P = 0.031), Simplified Comorbidity Score (P = 0.003), ECOG performance status (P = 0.016), FEV1% (P = 0.040), treating institution (P < 0.0001) and time period (P = 0.016) were associated with curative radiotherapy on multivariate analysis. In patients with T1-2N0M0 NSCLC, 19 (31%) who did not receive treatment and 7 (21%) who underwent palliative radiotherapy were technically and clinically suitable for SABR. Conclusion: Only 57% of patients with Stage I-II NSCLC were treated with curative radiotherapy. Patient factors were the predominant reason for palliative treatment, however, treating institution also played a role. A considerable proportion of patients who underwent palliative or no radiotherapy were suitable for SABR treatment.

Population-based analysis of curative therapies in stage II non-small cell lung cancer: the role of radiotherapy in medically inoperable patients

“…A significant proportion of patients received curative intent radiotherapy due to medical inoperability or patient decision. The survival outcomes in our study were similar to previously published reports [17,[28][29][30], although inferior to surgery with 5-year OS being 26%. In both a multivariate model and a case-matched analysis, the performance of surgery remained superior to curative intent radiotherapy.…”

“…Guidelines for locally advanced NSCLC suggest that a dose of 60 Gy should be used when treating with definitive radiotherapy, but it is not clear if this can be extrapolated to stage II disease [34]. Prior retrospective studies have defined curative radiotherapy for early stage NSCLC as a minimum dose of 50Gy [29,30]. Our study showed superior outcomes in patients treated with > 60 Gy compared to those treated with lower doses of potentially curative radiotherapy, which is consistent with other retrospective studies [17].…”

Trends and variations in treatment of stage I–III non-small cell lung cancer from 2008 to 2018: A nationwide population-based study from the Netherlands

“…Studies from the Netherlands and Australia comparing the periods before and after the clinical introduction of SBRT, showed a shift from palliative radiotherapy/best supportive care to curative radiotherapy [12,15,18]. Our study included the period after the implementation of RT: radiotherapy; OR: odds ratio; CI: confidence interval; p25: 25th percentile; p75: 75th percentile; values in bold are statistically significant.…”

“…Around 2010, SBRT was included in international guidelines as an alternative treatment option for inoperable patients with peripheral tumors, but not for those who are considered operable [4][5][6][7][8][9]. On the other hand, several authors have reported an increasing use of SBRT in early-stage NSCLC, both in operable patients instead of surgery [17] and in patients who previously would have received best supportive care alone [12,15,18].…”

Optimal and actual rates of Stereotactic Ablative Body Radiotherapy (SABR) utilisation for primary lung cancer in Australia

“…Practice pattern studies have revealed wide variations in radiotherapy utilisation across different populations as well as service providers [10] , [11] , [12] , [13] , [14] , [15] , highlighting the need for establishing valid benchmarks of optimal utilisation rates that reflect actual demands within the population. Evidence-based models have previously been used to determine optimal utilisation rates for different radiotherapy and chemotherapy treatments [3] , [16] , [17] .…”