title: Stage III non-small-cell lung cancer: population-based patterns of treatment in British Columbia, Canada.
abstract: BACKGROUND
  Management of Stage III non-small-cell lung cancer (NSCLC) involves surgery, radiotherapy (RT), chemotherapy, and best supportive care. The aims were to describe the patterns of treatment in a population-based cohort of patients, and compare utilization of RT and chemotherapy to model estimates of need.
  
  
  METHODS
  Patients diagnosed with Stage III NSCLC between January 1, 2000, to December 31, 2007, were identified from the British Columbia Cancer Agency database. Patients who had prior or concomitant malignancy were excluded. Patient demographics, tumor characteristics, and initial treatment were extracted. Survival data were derived from the British Columbia Vital Statistics Death Listings.
  
  
  RESULTS
  2365 patients with Stage III NSCLC were referred, of which 212 patients were excluded, leaving 2153 patients in the study population. Median age was 69 years. Disease stage was IIIA in 49% and IIIB in 51%. Histologies were squamous-cell carcinoma (31%), adenocarcinoma (27%), NSCLC not otherwise specified (31%), and other pathology (11%). Initial treatment included surgery in 12%, RT in 78%, and chemotherapy in 31%. Predicted RT utilization was 77% to 87% and chemotherapy 78%. From 2000 to 2007, curative-intent treatment increased from 21% to 35%, chemoradiotherapy from 8% to 18.6%, and concurrent chemoradiotherapy from 5.1% to 17.6%. Median survival was 30 months for patients who had curative surgery, 21 months for curative RT, 8 months for palliative treatment, and 5 months for best supportive care (p < 0.001).
  
  
  CONCLUSIONS
  RT utilization was similar to that predicted by models whereas chemotherapy utilization was less. During the study period, the proportion of patients receiving curative chemoradiotherapy doubled and of those receiving concurrent chemoradiotherapy trebled.
authors.affiliation: Collaboration for Cancer Outcomes, Research & Evaluation (CCORE), Liverpool Hospital, University of New South Wales, Sydney, Australia. Shalini.Vinod@sswahs.nsw.gov.au
authors.forename: Shalini K
authors.initials: SK
authors.lastname: Vinod
authors.forename: Elaine
authors.initials: E
authors.lastname: Wai
authors.forename: Cheryl
authors.initials: C
authors.lastname: Alexander
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
authors.forename: Nevin
authors.initials: N
authors.lastname: Murray
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D018287:Carcinoma, Large Cell / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011013:Pneumonectomy; D011379:Prognosis; D011879:Radiotherapy Dosage; D015996:Survival Rate