title: Palliative radiation therapy practice in patients with metastatic non-small-cell lung cancer: a Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) Study.
abstract: OBJECTIVE
  Randomized data suggest that single-fraction or short-course palliative radiation therapy (RT) is sufficient in the majority of patients with metastatic cancer. We investigated population-based patterns in the use of palliative RT among patients with metastatic non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  From patients diagnosed with lung cancer from 2003 to 2005 at a participating geographic or organizational site and who consented to the Cancer Care Outcomes Research and Surveillance Consortium study, we identified patients with metastatic NSCLC who had complete medical records abstractions. Patient characteristics and clinical factors associated with receipt of palliative RT and RT intensity (total dose and number of treatments) were evaluated with multivariable regression.
  
  
  RESULTS
  Of 1,574 patients with metastatic NSCLC, 780 (50%) received at least one course of RT, and 21% and 12% received RT to the chest and bone, respectively. Use of palliative RT was associated with younger age at diagnosis and receipt of chemotherapy and surgery to metastatic sites. Among patients receiving palliative bone RT, only 6% received single-fraction treatment. Among patients receiving palliative chest RT, 42% received more than 20 fractions. Patients treated in integrated networks were more likely to receive lower doses and fewer fractions to the bone and chest.
  
  
  CONCLUSIONS
  When palliative RT is used in patients with metastatic NSCLC, a substantial proportion of patients receive a greater number of treatments and higher doses than supported by current evidence, suggesting an opportunity to improve care delivery.
authors.affiliation: Dana-Farber Cancer Institute, 450 Brookline Ave, D1111, Boston, MA 02215, USA. achen7@partners.org
authors.forename: Aileen B
authors.initials: AB
authors.lastname: Chen
authors.forename: Angel
authors.initials: A
authors.lastname: Cronin
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.forename: James A
authors.initials: JA
authors.lastname: Hayman
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000556:secondary; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D014481:United States