Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
Molecular Oncology Unit, Department of Biological Chemistry, School of Medicine, University of Athens, Athens, Greece.
Lung Cancer. 2014 Jul;85(1):74-80. doi: 10.1016/j.lungcan.2014.03.010. Epub 2014 Mar 16.
Early stage Non-Small Cell Lung Cancer (NSCLC) is potentially curable with surgery. ESMO guidelines recommend cisplatin-based adjuvant chemotherapy (CT) for completely resected stage II-III NSCLC. There is limited evidence for the use of adjuvant CT and/or radiotherapy (RT) in incompletely resected (R1) early stage NSCLC.
A European survey of thoracic oncologists was conducted to evaluate use of adjuvant CT and RT for R1-resected NSCLC and to identify factors influencing treatment decisions. Demographics and information on clinical stage, regimens, cycles planned, radiotherapy sites, multidisciplinary management and discussion about inconclusive evidence with the patient were collected. Univariate and multivariate analyses were performed.
768 surveys were collected from 41 European countries. 82.9% of participants were medical oncologists; 49.3% ESMO members; 37.1% based in University Hospitals; 32.6% practicing oncology for over 15 years and 81.4% active in research. 91.4% of participants prescribed adjuvant CT and mostly cisplatin/vinorelbine (81.2%) or cisplatin/gemcitabine (42.9%). 85% discussed limited clinical evidence with the patient. In the univariate analysis, a statistically significant association with CT prescription was found for medical oncology specialty (p<0.001), ESMO membership (p<0.001), activity in clinical research (p=0.002) and increased frequency of ESMO guidelines consultation (p for trend <0.001). 48.3% of participants prescribed adjuvant RT and its prescription were associated with radiation oncology specialty (p<0.001), not being an ESMO member (p<0.001), years practicing specialty (p for trend=0.001), workload of lung cancer patients (p for trend=0.027) and decreased frequency in consulting ESMO guidelines (p<0.001). In the multivariate analysis, medical oncology and radiation oncology were the best discriminator for prescription of adjuvant CT and RT, respectively.
This survey demonstrates that adjuvant CT and RT are commonly used in clinical practice for R1-resected NSCLC despite limited evidence. Prospective trials are necessary to clarify optimal management in this setting.
早期非小细胞肺癌（NSCLC）通过手术治疗有治愈的可能。欧洲肿瘤内科学会（ESMO）指南建议对完全切除的 II-III 期 NSCLC 患者采用顺铂为基础的辅助化疗（CT）。对于未完全切除（R1）的早期 NSCLC 患者，辅助 CT 和/或放疗（RT）的应用证据有限。
对欧洲胸科肿瘤医生进行了一项调查，以评估 R1 切除的 NSCLC 患者中辅助 CT 和 RT 的应用，并确定影响治疗决策的因素。收集了人口统计学数据和临床分期、方案、计划周期、放疗部位、多学科管理以及与患者讨论不确定证据的信息。进行了单变量和多变量分析。
从 41 个欧洲国家共收集了 768 份调查。82.9%的参与者为肿瘤内科医生；49.3%为 ESMO 成员；37.1%来自大学医院；32.6%从事肿瘤学工作超过 15 年，81.4%积极从事研究。91.4%的参与者开具了辅助 CT 处方，最常使用的方案为顺铂/长春瑞滨（81.2%）或顺铂/吉西他滨（42.9%）。85%的参与者与患者讨论了有限的临床证据。单变量分析显示，肿瘤内科专业（p<0.001）、ESMO 会员资格（p<0.001）、临床研究活动（p=0.002）和 ESMO 指南咨询频率增加（p<0.001）与 CT 处方开具具有统计学显著相关性。48.3%的参与者开具了辅助 RT 处方，其处方开具与放射肿瘤学专业（p<0.001）、非 ESMO 成员（p<0.001）、专业工作年限（p 趋势=0.001）、肺癌患者工作量（p 趋势=0.027）和 ESMO 指南咨询频率降低（p<0.001）相关。多变量分析显示，肿瘤内科和放射肿瘤学是辅助 CT 和 RT 处方的最佳区分因素。
尽管证据有限，但本调查表明，辅助 CT 和 RT 在 R1 切除的 NSCLC 患者的临床实践中得到了广泛应用。需要前瞻性试验来明确该治疗方案在该患者人群中的最佳管理。
