title: Process of care and preliminary outcome in limited-stage small-cell lung cancer: results of the 1995-1997 patterns of care study in Japan.
abstract: OBJECTIVE
  To evaluate the practice process using the national average (NA); to compare differences in the process of care by age group; and to provide a preliminary outcome data for limited-stage small-cell lung cancer in Japan.
  
  
  METHODS
  The Patterns of Care Study conducted a nationwide survey of the care process for Stage I-III small-cell lung cancer in Japan. Patients were divided into three age groups: <65 years (younger group, n = 73); between 65 and 74 years (intermediate group, n = 81); and >or=75 years (elderly group, n = 20).
  
  
  RESULTS
  The NA for the total dose was 49.0 Gy, and for use of photon energy >or=6 MV, chemotherapy, and prophylactic cranial irradiation was 77.3%, 93.2%, and 1.69%, respectively. Age stratification had no impact on the variables of radiotherapy (RT) such as total dose and field size. Only 37% of patients received chemotherapy and thoracic RT concurrently. The proportion of patients who received chemotherapy and RT concurrently was 44%, 27%, and 25% of the younger, intermediate, and elderly groups, respectively (p = 0.029). Etoposide and cisplatin were less frequently used in the elderly group (>or=75 years old). Overall survival at 3 years for the entire group was 26%. The 3-year survival rate was 30% in the younger group, 28% in the intermediate group, and 9% in the elderly group. Variables found to have a significant impact on survival by multivariate analysis were the use of chemotherapy (p = 0.030), age (p = 0.032), and T stage (p = 0.042).
  
  
  CONCLUSIONS
  Calculated NAs showed that the results of clinical study had favorably penetrated into the practice process in Japan. The results demonstrated that patient age significantly influenced the process of chemotherapy such as the use of etoposide and cisplatin for limited-stage small-cell lung cancer in Japan. More concurrent chemotherapy and thoracic RT and the application of prophylactic cranial irradiation for complete responders need to be investigated in the future.
authors.affiliation: Department of Radiation Oncology, Chiba University Graduate School of Medicine, Chiba City, Japan. unotakas@ho.chiba-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Uno
authors.forename: Minako
authors.initials: M
authors.lastname: Sumi
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Sawa
authors.forename: Teruki
authors.initials: T
authors.lastname: Teshima
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Hara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikeda
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000367:Age Factors; D000368:Aged; D019985:Benchmarking; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000532:radiotherapy*; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis