Pattern of use of radiotherapy for lung cancer: a descriptive study

BMC Cancer

Isabel Tovar⁴  Jose Expósito⁴  Javier Jaén¹  Enrique Alonso³  Miguel Martínez⁴  Rosa Guerrero⁴  Juan P Arrebola²  Rosario Del Moral⁴ 

[1] Institute of Oncology, Cartuja, Sevilla, Spain

[2] CIBER en Epidemiología y Salud Pública (CIBERESP), Granada, Spain

[3] Radiation Oncology Department, Puerta del Mar Universitary Hospital, Cádiz, Spain

[4] Radiation Oncology Department, Virgen de las Nieves Universitary Hospital, Granada, Spain

关键词: Small cell lung cancer;    Clinical practice patterns;    Radiotherapy;    Non-small cell lung cancer;   

Others  :  1121044
DOI  :  10.1186/1471-2407-14-697

 received in 2013-07-06, accepted in 2014-09-18,  发布年份 2014

【 摘 要 】

Background

Lung cancer remains one of the most prevalent forms of cancer. Radiotherapy, with or without other therapeutic modalities, is an effective treatment. Our objective was to report on the use of radiotherapy for lung cancer, its variability in our region, and to compare our results with the previous study done in 2004 (VARA-I) in our region and with other published data.

Methods

We reviewed the clinical records and radiotherapy treatment sheets of all patients undergoing radiotherapy for lung cancer during 2007 in the 12 public hospitals in Andalusia, an autonomous region of Spain. Data were gathered on hospital, patient type and histological type, radiotherapy treatment characteristics, and tumor stage.

Results

610 patients underwent initial radiotherapy. 37% of cases had stage III squamous cell lung cancer and were treated with radical therapy. 81% of patients with non-small and small cell lung cancer were treated with concomitant chemo-radiotherapy and the administered total dose was ≥ 60 Gy and ≥ 45 Gy respectively. The most common regimen for patients treated with palliative intent (44.6%) was 30 Gy. The total irradiation rate was 19.6% with significant differences among provinces (range, 8.5-25.6%; p < 0.001). These differences were significantly correlated with the geographical distribution of radiation oncologists (r = 0.78; p = 0.02). Our results were similar to other published data and previous study VARA-I.

Conclusions

Our results shows no differences according to the other published data and data gathered in the study VARA-I. There is still wide variability in the application of radiotherapy for lung cancer in our setting that significantly correlates with the geographical distribution of radiation oncologists.

【 授权许可】

   
2014 Tovar et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Halpering EC, Perez CA, Brady LW: Principles and Practice of radiation Oncology. Philadelphia: Lippincott Williams & Wilkins; 2008.
• [2]Abente L: La Situación del Cáncer en España. Instituto de Salud Carlos III. Madrid: Ministerio de Sanidad y Consumo; 2005.
• [3]Sánchez de Cos J: LC in Spain. Current Epidemiology, Survival, and Treatment. Arch Bronconeumol 2009, 45(7):341-348.
• [4]Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A: Lung cancer. In AJCC Cancer Staging Manual. 7th edition. Edited by American Joint Committee on Cancer (AJCC). New York: Springer-Verlag; 2010:299-323.
• [5]Rubin P: Clinical Oncoly. A multidisciplinary approach for physicians and students. Philadelphia: WB Saunders Co.; 2001.
• [6]American College of Chest Physicians (ACCP): The LC Guideline. (2th edition). Chest 2007, 132(Suppl 3):1-328.
• [7]Cottish Intercollegiate Guideline Network: Management of patients with LC. A national clinical guideline. Scotland, United Kingdom: Scottish Intercollegiate Guideline Network. 2005. [http://www.sign.ac.uk/pdf/sign80.pdf webcite]
• [8]National Institute for Health and Clinical Excellence (NICE): The diagnoses and treatment of Lung Cancer (CG 121). [http://guidance.nice.org.uk/cg121 webcite]
• [9]DeVita VT, Hellman S, Rosemberg SA: Cáncer. Médica Panamericana: Principios y Prácticas de Oncología. Madrid; 2000.
• [10]Mackillop WJ, Dixon P, Zhou Y, Ago CT, Ege G, Hodson DI, Kotalik JF, Lochrin C, Paszat L, Harris D: Variation in the management and outcome of non-small cell lung cancer in Ontario. Radiother Oncol 1994, 32(2):106-115.
• [11]Kepka L, Danilova V, Saghatelyan T, Bajcsay A, Utehina O, Stojanovic S, Yalman D, Demiral A, Bondaruk O, Kuddu M, Jeremic B, International Atomic Energy Agency (IAEA): Resources and management strategies for the use of radiotherapy in the treatment of lung cancer in Central and Eastern European countries: results of an International Atomic Energy Agency (IAEA) survey. Lung Cancer 2007, 56(2):235-245.
• [12]Wennberg JE, Gittelsohn AM: Variations in medical care among small areas. Sci Am 1982, 264:100-111.
• [13]Wennberg JE, Gittelsohn AM: A small area variations in health care delivery. A population-based health information system can guide planning and regulatory decision-making. Science 1973, 18:1.102-1.108.
• [14]Jaén J, Alonso E, Expósito J, de las Peñas MD, Cabrera P: Evidence-based estimation and radiotherapy utilization rate in Andalusia. Clin Translat Oncol 2007, 9:789-796.
• [15]National Statistic Institute (NSI) [http//www.ine.es webcite]
• [16]Granada Cancer Registry (GCR) [http://www.cancergranada.org/en/granada_cancer_registry_about_us.cfm webcite]
• [17]American Joint Committee on Cancer (AJCC): AJCC Cancer Staging Manual. New York, PA: Springer-Verlag; 2002.
• [18]Salmerón D, Chirlaque MD, Isabel Izarzugaza M, Sánchez MJ, Marcos-Gragera R, Ardanaz E, Galceran J, Mateos A, Navarro C: Lung cancer prognosis in Spain: The role of histology, age and sex. Respir Med 2012, 106:1301-1308.
• [19]Escuín JS: Lung cancer in Spain. Current Epidemiology, Survival, and Treatment. Arch Bronconeumol 2009, 45(7):341-348.
• [20]Prim JM, Barcala FJ, Esquete JP, Reino AP, López AF, Cuadrado LV: Lung cancer in a health area of Spain: incidence, characteristics and survival. Eur J Cancer Care 2010, 19(2):227-233.
• [21]Sánchez de Cos Escuín J, Miravet Sorribes L, Abal Arca J, Núñez Ares A, Hernández Hernández J, Castañar Jover AM, Muñoz Gutiérrez FJ, García Arangüena L, Alonso MA, Montero Martínez MC, Allende González J, Sánchez Hernández I: Estudio multicéntrico epidemiológico-clínico de cáncer de pulmón en España (estudio EpicliCP-2003). Arch Bronconeumol 2006, 42(9):446-452.
• [22]Hernández Hernández JR, del Pozo JA T, Moreno Canelo P, Rodríguez Puebla A, Paniagua Tejo S, Sánchez Marcos JC: Incidencia del cáncer de pulmón en la provincia de Ávila. Año 2002 y tendencias en una década. Arch Bronconeumol 2004, 40(7):304-310.
• [23]Santos-Martínez MJ, Curull V, Blanco ML, Macià F, Mojal S, Vila J, Broquetas JM: Lung cancer at a University Hospital: epidemiological and histological characteristics of a recent and a historical series. Arch Bronconeumol 2005, 41(6):301-312.
• [24]Estrada Trigueros G, Comeche L, López Encuentra A, Montoro Zulueta J, González Garrido F, Colina F: Carcinoma broncogénico 2000–2001: características y supervivencia global. Arch Bronconeumol 2007, 43(11):594-598.
• [25]Alonso-Fernández MA, García-Clemente M, Escudero-Bueno C: Características del carcinoma broncopulmonar en una región del norte de España. Arch Bronconeumol 2005, 41(9):478-483.
• [26]Alberg AJ, Ford JG, Samet JM: Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007, 132(Suppl 3):29-55.
• [27]Janssen-Heijnen ML, Coebergh JW: The changing epidemiology o lung cancer in Europe. Lung Cancer 2003, 41(3):245-258.
• [28]Movsas B, Moughan J, Komaki R, Choy H, Byhardt R, Langer C, Goldberg M, Graham M, Ettinger D, Johnstone D, Abrams R, Munden R, Starkschall G, Owen J: Radiotherapy patterns of care study in lung carcinoma. J Clin Oncol 2003, 21:453-459.
• [29]Barbera L, Zhang-Salomon J, Huang J, Tyldesley S, Mackillop W: Defining the need for radiotherapy for lung cancer in the general population. A criterion-based, benchmarking approach. Medical Care 2003, 41(9):1074-1085.
• [30]Tyldesley S, Delaney G, Foroudi F, Barbera L, Kerba M, Mackillop W: Estimating the need for radiotherapy for patients with prostate, breast, and lung cancers: verification of model estimates of need with radiotherapy utilization data from British Columbia. Int J Radiat Oncol Biol Phys 2011, 1; 79(5):1507-1515.
• [31]Delaney G, Jacob S, Featherstone C, Barton M: The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 2005, 104:1129-1137.
• [32]Bentzen SM, Heeren G, Cottier B, Slotman B, Glimelius B, Lievens Y, van den Bogaert W: Towards evidence-based guidelines for radiotherapy infrastructure and staffing needs in Europe: the ESTRO QUARTS project. Radiother Oncol 2005, 75:355-365.
• [33]Tovar I, Expósito J, Jaén J, Alonso E: Underuse of radiotherapy in lung cancer has negative consequences for patients. J Thorac Oncol 2013, 8(1):62-67.
• [34]Vinod SK, Simonella L, Goldsbury D, Delaney GP, Armstrong B, O'Connell DL: Underutilization of radiotherapy for lung cancer in New South Wales, Australia. Cancer 2010, 116(3):686-694.
• [35]Jack RH, Gulliford MC, Ferguson J, Møller H: Explaining inequalities in access to treatment in lung cancer. J Eval Clin Pract 2006, 12(5):573-582.
• [36]Tai P, Yu E, Battista J, Van Dyk J: Radiation treatment of lung cancer–patterns of practice in Canada. Radiother Oncol 2004, 71(2):167-174.
• [37]Lee IH, Hayman JA, Landrum MB, Tepper J, Tao ML, Goodman KA, Keating NL: Treatment recommendations for locally advanced, non-small-cell lung cancer: the influence of physician and patient factors. Int J Radiat Oncol Biol Phys 2009, 74(5):1376-1384.
• [38]Loannidis JPA, Pavlidis N: Levels of Absolute survival benefit for systematic therapies of advanced cancer: a call for standards. Eur J Canc 2003, 39:1194-1198.
• [39]Goffin J, Lacchetti C, Ellis PM, Ung YC, Evans WK: First-line chemotherapy in the treatment of advanced Non-small cell lung cancer. A systematic review. J Thorac Oncol 2010, 5:260-274.