Post Carl M, Verma Vivek, Mitin Timur, Simone Charles B
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE.
Department of Radiation Medicine, Oregon Health and Science University, Portland, OR.
Clin Lung Cancer. 2017 May;18(3):310-315.e1. doi: 10.1016/j.cllc.2016.12.004. Epub 2016 Dec 22.
Despite the recent CREST trial demonstrating a survival benefit to thoracic radiotherapy (TRT) for patients with extensive-stage small-cell lung cancer (ES-SCLC) with response to chemotherapy, as well as endorsement by current National Comprehensive Cancer Network guidelines, TRT may not be uniformly delivered in clinical practice across all circumstances.
We surveyed US academic thoracic radiation oncologists regarding their practice patterns for TRT and assessed conditions in which withholding TRT could be warranted. A 27-question survey of demographics and practice patterns, including 5 clinical cases, was sent to 111 physicians.
Response rate was 39% (43/111). Among respondents, 60% have at least 6 years of work experience following residency; 77% and 71% respectively see > 50 lung cancer and > 11 SCLC cases annually. Regarding practice patterns, 74% use TRT in 26% to 75% of patients with ES-SCLC. Respondents would withhold TRT in cases with Eastern Cooperative Oncology Group performance status ≥ 3 (91%), when pulmonary function necessitates continuous oxygen via nasal cannula (62%), for postchemotherapy tumor progression (58%), and if > 4 postchemotherapy extrathoracic metastases were present (58%). The 5 clinical cases highlighted practice variability, although 1 case had 100% agreement among respondents.
Despite support of TRT administration from the CREST trial, there are several conditions associated with frequently withholding TRT. The most common reasons include performance status, postchemotherapy extent of disease, and pulmonary function; age and prechemotherapy extent of disease were least associated. Further research should aim to identify which subgroups of ES-SCLC benefit most from TRT.
尽管最近的CREST试验表明，对于化疗有反应的广泛期小细胞肺癌（ES - SCLC）患者，胸段放疗（TRT）可带来生存获益，并且当前美国国立综合癌症网络指南也认可这一点，但在临床实践中，TRT可能无法在所有情况下都得到统一应用。
我们调查了美国学术性胸段放射肿瘤学家的TRT实践模式，并评估了有理由不进行TRT的情况。一项包含27个关于人口统计学和实践模式问题（包括5个临床病例）的调查问卷被发送给了111位医生。
回复率为39%（43/111）。在受访者中，60%在完成住院医师培训后至少有6年工作经验；77%和71%的人每年分别诊治超过50例肺癌和超过11例SCLC病例。关于实践模式，74%的人在26%至75%的ES - SCLC患者中使用TRT。受访者会在以下情况下不进行TRT：东部肿瘤协作组体能状态≥3（91%）、肺功能需要通过鼻导管持续吸氧（62%）、化疗后肿瘤进展（58%）以及化疗后存在超过4个胸外转移灶（58%）。这5个临床病例凸显了实践的差异性，尽管有1个病例在受访者中达成了100%的共识。
尽管CREST试验支持进行TRT，但仍有几种情况常导致不进行TRT。最常见的原因包括体能状态、化疗后疾病范围和肺功能；年龄和化疗前疾病范围与之关联最小。进一步的研究应旨在确定ES - SCLC的哪些亚组从TRT中获益最大。
