title: Radiotherapy in Italy for non-small cell lung cancer: patterns of care survey.
abstract: OBJECTIVE
  Surveys in clinical practice are useful to find how current clinical approaches follow recommendations from evidence-based medicine, to stimulate discussion in a multidisciplinary team, and to hypothesize collaborative multicentric trials. To assess management strategies for the use of radiotherapy in the treatment of lung cancer in Italy, in 2009, the Italian Society of Radiation Oncology Lung Cancer Study Group proposed the survey to all Italian radiation oncology institutions. Results were compared with literature data and international reports.
  
  
  METHODS
  Questionnaires on patterns of care of non-small cell lung cancer were sent to radiation oncology centers active at June 2009 and evaluated data recorded in 2008.
  
  
  RESULTS
  A total of 65 of 143 Italian centers responded to the questionnaire. The responding centers reflect the distribution of radiotherapy centers throughout the country. Of the treated patients, 55.2% were stage III, and most cases had a good performance status. FDG-PET was routinely used by 51% of centers for diagnostic and contouring phases. Postoperative radiotherapy was prescribed to pN1 and pN2 patients in 42.2% and 98.5%, respectively. The possible use of neo-adjuvant concomitant chemoradiation was declared by 70% of responders. A sequential chemoradiation approach was actually used in 43.6% of cases, induction chemotherapy followed by concomitant radiochemotherapy in 42.4%, and upfront concomitant radiochemotherapy in only 14%. In 53% of the institutions, patients have a clinical examination by a radiation oncologist only after the beginning of chemotherapy and in 82.4% of cases they have already received 2-4 cycles of chemotherapy. Most of the institutions exclude elective nodal irradiation from routine application. Total dose and fractionation in adjuvant, neoadjuvant, curative and palliative settings confirm literature data. There were significant differences in treatment planning constraints applied for lung, esophageal and cardiac tissues. Of the responding centers, 41% had stereotactic therapy for primary inoperable lung cancer and for metastatic lesions.
  
  
  CONCLUSIONS
  In Italy, daily practice differs in some ways from the evidence supported by the results of meta-analyses/clinical trials as regards concurrent chemoradiation approaches. It could be postulated that there is an urgent need for groups that collaborate with the other societies involved in the treatment of non-small cell lung cancer in order to offer the best therapy to our patients.
authors.affiliation: Radiation Oncology, Campus Bio-Medico University, Rome, Italy. s.ramella@unicampus.it
authors.forename: Sara
authors.initials: S
authors.lastname: Ramella
authors.forename: Ernesto
authors.initials: E
authors.lastname: Maranzano
authors.forename: Paolo
authors.initials: P
authors.lastname: Frata
authors.forename: Cristina
authors.initials: C
authors.lastname: Mantovani
authors.forename: Grazia
authors.initials: G
authors.lastname: Lazzari
authors.forename: Claudia
authors.initials: C
authors.lastname: Menichelli
authors.forename: Piera
authors.initials: P
authors.lastname: Navarria
authors.forename: Stefano
authors.initials: S
authors.lastname: Pergolizzi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Salvi
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine; D005260:Female; D019788:Fluorodeoxyglucose F18; D019538:Health Care Surveys; D006321:Heart / Q000528:radiation effects; D006801:Humans; D007558:Italy; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals; D013238:Stereotaxic Techniques; D011795:Surveys and Questionnaires
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18