title: Penetration of recommended procedures for lung cancer staging and management in the United States over 10 years: a quality research in radiation oncology survey.
abstract: OBJECTIVE
  To document the penetration of clinical trial results, practice guidelines, and appropriateness criteria into national practice, we compared the use of components of staging and treatment for lung cancer among patients treated in 2006-2007 with those used in patients treated in 1998-1999.
  
  
  METHODS
  Patient, staging work-up, and treatment characteristics were extracted from the process survey database of the Quality Research in Radiation Oncology (QRRO), consisting of records of 340 patients with locally advanced non-small cell lung cancer (LA-NSCLC) at 44 institutions and of 144 patients with limited-stage small cell lung cancer (LS-SCLC) at 39 institutions. Data were compared for patients treated in 2006-2007 versus those for patients treated in 1998-1999.
  
  
  RESULTS
  Use of all recommended procedures for staging and treatment was more common in 2006-2007. Specifically, disease was staged with brain imaging (magnetic resonance imaging or computed tomography) and whole-body imaging (positron emission tomography or bone scanning) in 66% of patients with LA-NSCLC in 2006-2007 (vs 42% in 1998-1999, P=.0001) and in 84% of patients with LS-SCLC in 2006-2007 (vs 58.3% in 1998-1999, P=.0011). Concurrent chemoradiation was used for 77% of LA-NSCLC patients (vs 45% in 1998-1999, P<.0001) and for 90% of LS-SCLC patients (vs 62.5% in 1998-1999, P<.0001). Use of the recommended radiation dose (59-74 Gy for NSCLC and 60-70 Gy as once-daily therapy for SCLC) did not change appreciably, being 88% for NSCLC in both periods and 51% (2006-2007) versus 43% (1998-1999) for SCLC. Twice-daily radiation for SCLC was used for 21% of patients in 2006-2007 versus 8% in 1998-1999. Finally, 49% of patients with LS-SCLC received prophylactic cranial irradiation (PCI) in 2006-2007 (vs 21% in 1998-1999).
  
  
  CONCLUSIONS
  Although adherence to all quality indicators improved over time, brain imaging and recommended radiation doses for stage III NSCLC were used in <90% of cases. Use of full thoracic doses and PCI for LS-SCLC also requires improvement.
authors.affiliation: Departmentof Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA. rkomaki@mdanderson.org
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Najma
authors.initials: N
authors.lastname: Khalid
authors.forename: Corey J
authors.initials: CJ
authors.lastname: Langer
authors.forename: Feng-Ming Spring
authors.initials: FM
authors.lastname: Kong
authors.forename: Jean B
authors.initials: JB
authors.lastname: Owen
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Crozier
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wilson
authors.forename: Xiong
authors.initials: X
authors.lastname: Wei
authors.forename: Benjamin
authors.initials: B
authors.lastname: Movsas
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000706:statistics & numerical data; D016371:Cranial Irradiation / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods* / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D018787:Radiation Oncology / Q000592:standards / Q000706:statistics & numerical data*; D055752:Small Cell Lung Carcinoma / Q000473:pathology / Q000628:therapy; D013997:Time Factors; D014481:United States