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Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions.

Publication ,  Journal Article
Valle, LF; Jagsi, R; Bobiak, SN; Zornosa, C; D'Amico, TA; Pisters, KM; Dexter, EU; Niland, JC; Hayman, JA; Kapadia, NS
Published in: Int J Radiat Oncol Biol Phys
February 1, 2016

PURPOSE: 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 AND MATERIALS: 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.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

February 1, 2016

Volume

94

Issue

2

Start / End Page

360 / 367

Location

United States

Related Subject Headings

  • Radiotherapy
  • Practice Patterns, Physicians'
  • Postoperative Complications
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Mediastinoscopy
  • Male
  • Lung Neoplasms
  • Humans
 

Citation

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Valle, L. F., Jagsi, R., Bobiak, S. N., Zornosa, C., D’Amico, T. A., Pisters, K. M., … Kapadia, N. S. (2016). Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions. Int J Radiat Oncol Biol Phys, 94(2), 360–367. https://doi.org/10.1016/j.ijrobp.2015.10.030
Valle, Luca F., Reshma Jagsi, Sarah N. Bobiak, Carrie Zornosa, Thomas A. D’Amico, Katherine M. Pisters, Elisabeth U. Dexter, Joyce C. Niland, James A. Hayman, and Nirav S. Kapadia. “Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions.Int J Radiat Oncol Biol Phys 94, no. 2 (February 1, 2016): 360–67. https://doi.org/10.1016/j.ijrobp.2015.10.030.
Valle LF, Jagsi R, Bobiak SN, Zornosa C, D’Amico TA, Pisters KM, et al. Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions. Int J Radiat Oncol Biol Phys. 2016 Feb 1;94(2):360–7.
Valle, Luca F., et al. “Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions.Int J Radiat Oncol Biol Phys, vol. 94, no. 2, Feb. 2016, pp. 360–67. Pubmed, doi:10.1016/j.ijrobp.2015.10.030.
Valle LF, Jagsi R, Bobiak SN, Zornosa C, D’Amico TA, Pisters KM, Dexter EU, Niland JC, Hayman JA, Kapadia NS. Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions. Int J Radiat Oncol Biol Phys. 2016 Feb 1;94(2):360–367.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

February 1, 2016

Volume

94

Issue

2

Start / End Page

360 / 367

Location

United States

Related Subject Headings

  • Radiotherapy
  • Practice Patterns, Physicians'
  • Postoperative Complications
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Mediastinoscopy
  • Male
  • Lung Neoplasms
  • Humans