Changes in the patterns of care for small-cell-lung cancer (SCLC): Results of the 99–01 Patterns of Care Study (PCS) nationwide survey in Japan

Abstract

6085 Background: Several key studies for SCLC preceded 2nd PCS nationwide survey in Japan. This study was undertaken to analyze the process of thoracic radiotherapy (TRT) and to evaluate changes in the patterns of care for SCLC. Methods: Between July 2002 and August 2004, the PCS conducted a second nationwide audit survey of care process for stage I-III SCLC patients treated with TRT between 1999–2001. PCS investigated; 1) patient background, 2) work-up studies, 3) process of RT, and 4) process of chemotherapy. Practice patterns of 99–01 PCS were compared with those of 95–97 PCS. Results: By using two-stage cluster sampling, the PCS expert team collected data for 139 eligible SCLC patients (men to women ratio, 5:1; median age, 69; age>70, 43%; KPS>70, 73%; stage III, 89%) from 73 institutions. Pre-treatment work-up study included chest CT in 96%, fiberoptic scope in 93%, brain CT or MRI in 86%, bone scinti in 79%. The median total dose of TRT was 5000 cGy. Twice-daily radiotherapy (BID) was used in 43%. The median field size of TRT was 12 cm x 14 cm. TRT port included ipsilateral hilus in 96%, ipsilateral mediastinum in 96%, contralateral mediastinum in 84%, and contralateral hilus in 17%. Field reduction during TRT course in 61%. The most predominantly used photon energy was 10 MV (77%), whereas obsolete technique using Co-60 or X-ray energy < 6MV comprised 12%. 3D-conformal therapy was used in 12%. Dose prescription was at an isodose line in 15%. CT-simulation was performed in 40%. Only 12 patients (9%) received prophylactic cranial irradiation (PCI). Ninety-two percent received systemic chemotherapy, of those, platinum based chemotherapy constituted 98%, and 73% were treated by concurrent chemoradiation (CCRT). Treatment by IRB-approved protocol was only 6 cases (4%). Compared with the previous 95–97 PCS, in the management of SCLC, significant increases in the use of CCRT (73% vs 37%, P<0.0001), BID-TRT (43% vs 19%, P<0.0001), and PCI (9% vs 2%, P=0.01) were observed, although the absolute number of patients receiving PCI was still extremely low. Conclusions: Evidence based CCRT and BID-TRT for SCLC had well penetrated into clinical practice, however, PCI has not yet widely accepted in Japan. No significant financial relationships to disclose.