title: Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions.
abstract: OBJECTIVE
  This study determined practice patterns in the staging and treatment of patients with stage I non-small cell lung cancer (NSCLC) among National Comprehensive Cancer Network (NCCN) member institutions. Secondary aims were to determine trends in the use of definitive therapy, predictors of treatment type, and acute adverse events associated with primary modalities of treatment.
  
  
  METHODS
  Data from the National Comprehensive Cancer Network Oncology Outcomes Database from 2007 to 2011 for US patients with stage I NSCLC were used. Main outcome measures included patterns of care, predictors of treatment, acute morbidity, and acute mortality.
  
  
  RESULTS
  Seventy-nine percent of patients received surgery, 16% received definitive radiation therapy (RT), and 3% were not treated. Seventy-four percent of the RT patients received stereotactic body RT (SBRT), and the remainder received nonstereotactic RT (NSRT). Among participating NCCN member institutions, the number of surgeries-to-RT course ratios varied between 1.6 and 34.7 (P<.01), and the SBRT-to-NSRT ratio varied between 0 and 13 (P=.01). Significant variations were also observed in staging practices, with brain imaging 0.33 (0.25-0.43) times as likely and mediastinoscopy 31.26 (21.84-44.76) times more likely for surgical patients than for RT patients. Toxicity rates for surgical and for SBRT patients were similar, although the rates were double for NSRT patients.
  
  
  CONCLUSIONS
  The variations in treatment observed among NCCN institutions reflects the lack of level I evidence directing the use of surgery or SBRT for stage I NSCLC. In this setting, research of patient and physician preferences may help to guide future decision making.
authors: Geisel School of Medicine at Dartmouth College, Dartmouth College, Hanover, New Hampshire.
authors: Luca F
authors: LF
authors: Valle
authors: Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan.
authors: Reshma
authors: R
authors: Jagsi
authors: National Comprehensive Cancer Network, Fort Washington, Pennsylvania.
authors: Sarah N
authors: SN
authors: Bobiak
authors: National Comprehensive Cancer Network, Fort Washington, Pennsylvania.
authors: Carrie
authors: C
authors: Zornosa
authors: Department of Surgery, Division of Thoracic Surgery, Duke Cancer Institute, Durham, North Carolina.
authors: Thomas A
authors: TA
authors: D'Amico
authors: Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Katherine M
authors: KM
authors: Pisters
authors: Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York.
authors: Elisabeth U
authors: EU
authors: Dexter
authors: Department of Information Sciences, City of Hope Comprehensive Cancer Center, Duarte, California.
authors: Joyce C
authors: JC
authors: Niland
authors: Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan.
authors: James A
authors: JA
authors: Hayman
authors: Department of Radiation Oncology, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire. Electronic address: Nirav.S.Kapadia@hitchcock.org.
authors: Nirav S
authors: NS
authors: Kapadia
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008481:Mediastinoscopy / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D011878:Radiotherapy / Q000009:adverse effects