Changes in patterns of care for limited-stage small-cell lung cancer: results of the 99-01 patterns of care study-a nationwide survey in Japan.
BACKGROUND
This study was undertaken to analyze the practice process of thoracic radiotherapy (TRT) and evaluate changes in patterns of care for patients with limited-stage small-cell lung cancer (LS-SCLC) in Japan.


METHODS
The Patterns of Care Study (PCS) conducted the second nationwide survey of care process for patients with LS-SCLC treated by using TRT between 1999 and 2001.


RESULTS
The PCS collected data for 139 patients with LS-SCLC (man-woman ratio, 5:1; median age, 69 years; age > 70 years, 43%; Karnofsky Performance Status > 70, 73%; and Stage III, 88%). Median total dose was 50 Gy. Twice-daily TRT was used in 44% of patients. Median field size was 12 x 14 cm. The most commonly used photon energy was 10 MV (77%), whereas obsolete techniques using (60)Co or X-ray energy less than 6 MV comprised 12%. Three-dimensional conformal therapy was used with 12% of patients. Computed tomography simulation was performed in 40% of cases. Only 12 patients (8.6%) received prophylactic cranial irradiation (PCI). Concurrent chemotherapy and TRT (CCRT) was used for 94 patients (68%). Only 6 patients (4.4%) entered clinical trials. Compared with the previous PCS 95-97, significant increases in the use of CCRT (34-68%; p < 0.0001), twice-daily TRT (15-44%; p < 0.0001), and PCI (1.7-8.6%; p =0.0045) were observed, although the absolute number of patients receiving PCI was still extremely low.


CONCLUSIONS
Evidence-based CCRT and twice-daily TRT has penetrated into clinical practice. However, PCI is not yet widely accepted in Japan.
Uno
Takashi
T
Department of Radiology, Chiba University Graduate School of Medicine, Chiba, Japan. unotakas@faculty.chiba-u.jp
Sumi
Minako
M
Ishihara
Yoshitomo
Y
Numasaki
Hodaka
H
Mitsumori
Michihide
M
Teshima
Teruki
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000379:methods; D003198:Computer Simulation; D016371:Cranial Irradiation; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000639:trends; D018787:Radiation Oncology / Q000592:standards / Q000639:trends; D011878:Radiotherapy / Q000379:methods / Q000592:standards; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome