Despite the majority of radiation oncologists administering the National Comprehensive Cancer Network (NCCN) guideline-recommended thoracic radiotherapy schedule to patients with small-cell lung cancer, great variability still exists in dosing and fractionation, according to a recent survey.
The benefits of radiotherapy in limited-stage small-cell lung cancer have been demonstrated in multiple previous studies. However, the optimal dose and fractionation schedule of thoracic radiotherapy remains unclear.
The NCCN recommends radiation oncologists administer either 45 Gy twice daily, or 60 Gy to 70 Gy once daily. A recent survey, conducted by Matthew J Farrell, MD, Loyola University Chicago Stritch School of Medicine, sought to gain a better understanding of which dosing and fractionation regimen radiation oncologists are actually delivering to their patients. Using an Institutional Review Board-approved questionnaire, Dr Farrell and colleagues surveyed 309 radiation oncologists in the US. Questions related to background characteristics, self-rated knowledge of relevant trials, and treatment recommendations for limited-stage small-cell lung cancer.
Dr Farrell presented the findings at the International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology (September 14-16, 2017; Chicago, IL).
Results of the survey showed that 60% of radiation oncologists prefer to administer radiotherapy 60 Gy once daily. Seventy-six percent of respondents admitted this treatment option to be more common in their practice. Oncologists said they preferred once-daily dosing because it is more convenient for patients (71%), is logically easier for scheduling (43%), and is more tolerable for patients with low performance status (59%).
The stated preference of administering treatment once daily appeared to be in concordance with oncologists’ actual administration practices. On the contrary, 40% of radiation oncologists who admitted that the preferred twice-daily dosing actually administered a once-daily regimen more often than not.
Radiation oncologists who preferred twice-daily therapy cited shorter treatment duration for patients (51%), more established than once-daily dosing (58%), and not proven to be inferior to once-daily dosing (42%) as reasons for preference.
A majority of respondents (88%) recommended 45 Gy twice-daily administration, whereas those who recommended once-daily treatment suggested a range of doses – including 60 Gy (54%), 63 Gy to 66 Gy (30%), and 70 Gy (10%).
As more data from clinical trials become available, it will become clearer which dosing and fractionation schedule is optimal for patients with limited-stage small-cell lung cancer, Dr Farrell explained.—Zachary Bessette