title: Use of adjuvant chemotherapy (CT) and radiotherapy (RT) in incompletely resected (R1) early stage Non-Small Cell Lung Cancer (NSCLC): a European survey conducted by the European Society for Medical Oncology (ESMO) young oncologists committee.
abstract: BACKGROUND
  Early stage Non-Small Cell Lung Cancer (NSCLC) is potentially curable with surgery. ESMO guidelines recommend cisplatin-based adjuvant chemotherapy (CT) for completely resected stage II-III NSCLC. There is limited evidence for the use of adjuvant CT and/or radiotherapy (RT) in incompletely resected (R1) early stage NSCLC.
  
  
  METHODS
  A European survey of thoracic oncologists was conducted to evaluate use of adjuvant CT and RT for R1-resected NSCLC and to identify factors influencing treatment decisions. Demographics and information on clinical stage, regimens, cycles planned, radiotherapy sites, multidisciplinary management and discussion about inconclusive evidence with the patient were collected. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  768 surveys were collected from 41 European countries. 82.9% of participants were medical oncologists; 49.3% ESMO members; 37.1% based in University Hospitals; 32.6% practicing oncology for over 15 years and 81.4% active in research. 91.4% of participants prescribed adjuvant CT and mostly cisplatin/vinorelbine (81.2%) or cisplatin/gemcitabine (42.9%). 85% discussed limited clinical evidence with the patient. In the univariate analysis, a statistically significant association with CT prescription was found for medical oncology specialty (p<0.001), ESMO membership (p<0.001), activity in clinical research (p=0.002) and increased frequency of ESMO guidelines consultation (p for trend <0.001). 48.3% of participants prescribed adjuvant RT and its prescription were associated with radiation oncology specialty (p<0.001), not being an ESMO member (p<0.001), years practicing specialty (p for trend=0.001), workload of lung cancer patients (p for trend=0.027) and decreased frequency in consulting ESMO guidelines (p<0.001). In the multivariate analysis, medical oncology and radiation oncology were the best discriminator for prescription of adjuvant CT and RT, respectively.
  
  
  CONCLUSIONS
  This survey demonstrates that adjuvant CT and RT are commonly used in clinical practice for R1-resected NSCLC despite limited evidence. Prospective trials are necessary to clarify optimal management in this setting.
authors.affiliation: Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom. Electronic address: raffaele.califano@christie.nhs.uk.
authors.forename: R
authors.initials: R
authors.lastname: Califano
authors.affiliation: Molecular Oncology Unit, Department of Biological Chemistry, School of Medicine, University of Athens, Athens, Greece.
authors.forename: M V
authors.initials: MV
authors.lastname: Karamouzis
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Institut Jules Bordet and L' Université Libre de Brussels (U.L.B.), Brussels, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: de Azambuja
authors.affiliation: University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Guarneri
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Hutka
authors.affiliation: University Hospital of Halle, Halle, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Jordan
authors.affiliation: Department of Medical Oncology, University Hospital of Larissa, Larissa, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Kamposioras
authors.affiliation: Department of Internal and Experimental Medicine "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Martinelli
authors.affiliation: Instituto de Biomedicina de Sevilla and Hospital Universitario Virgen del Rocio, Seville, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Corral
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Postel-Vinay
authors.affiliation: Department of Medicine I and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Preusser
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Porcu
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Torri
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005060:Europe; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008495:Medical Oncology; D010820:Physicians; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018714:Radiotherapy, Adjuvant; D011795:Surveys and Questionnaires
keywords: Adjuvant chemotherapy; Adjuvant radiotherapy; Incomplete resection; Non-Small Cell Lung Cancer; R1; Survey