Differences in Pattern of Practice in Radiation Therapy for Patients With Non-Small Cell Lung Cancer (NSCLC) Between Physicians in China and the United States (US)

Abstract

Purpose/Objective(s)To study the pattern of practice in radiation therapy (RT) for NSCLC patients in China and compare the results with that of US.Materials/MethodsStudy questionnaires were designed by a panel of 8 Board certified radiation oncologists. The survey was sent through email to radiation oncologist members of American Society of Therapeutic Radiology and Oncology (ASTRO) in September, 2006, and to Chinese radiation oncologists in January, 2007. The results were collected online in March, 2007. There were a total of 492 responses: 425 from the US and 67 from China.ResultsChinese respondents saw an average of 14 new cases monthly, significantly more than US physicians (p < 0.001). The choices of treatment decision and RT prescription were heterogeneous among respondents. There was a significant difference in choices of radiation regimens for stage I peripherally located disease: 20% Chinese vs 34% of US chose conventional fractionated RT (p < 0.00), 43% Chinese vs 19% of US chose stereotactic RT (p < 0.001), 0% Chinese vs 14% of US chose stereotactic RT 18-20 Gy × 3, and 23% Chinese vs 1.5% of US chose 6 Gy ×10 (p < 0.001). For stage I centrally located disease, the majority of respondents selected conventional fractionated RT in both countries: 28% of Chinese vs 8% of US chose stereotactic RT (p < 0.001). For stage II disease, a majority of respondents chose concurrent chemoradiation (64% Chinese vs 85% of US, p < 0.001), with radiation dose of 60–70 Gy in 1.8–2 Gy daily fractions (79% of US vs 69% Chinese). For stage III patients with a performance score of 70–100%, the dominant pattern of practice was concurrent chemoradiation followed by adjuvant chemotherapy (61% Chinese vs 85% of US respondents, p < 0.001); 16% Chinese vs 1% of US chose sequential chemoradiation (p < 0.001). For patients with performance score of 50–60%, 36% of Chinese and 41% of US respondents chose fractionated RT alone, 0% Chinese vs 11% of US chose concurrent chemoradiation followed by adjuvant chemotherapy, 22% Chinese vs 17% of US chose chemotherapy followed by RT, 13% Chinese vs 20% of US chose RT followed by chemotherapy (p < 0.001). Regarding choices of dose fractionation, 45% Chinese vs 79% of US respondents (p < 0.001) chose 60–70 Gy in 1.8–2 Gy daily fractions, 48% Chinese vs 13% of US chose exactly 60 Gy in 2 Gy daily fractions (p < 0.001). For stage IV disease with good performance score, 50% Chinese 27% of US respondents chose 2 Gy × 30 (p = 0.001), fewer Chinese respondents chose lower doses or no radiation (p = 0.001). For patients with stage IV with hemoptysis or obstructive lung disease with asymptomatic distant metastasis, Chinese respondents tended to choose chemotherapy followed by RT (39%) more than 3 Gy ×10 followed by chemotherapy (10%), which is the opposite of respondents of the US (5% vs 43%, p < 0.001).ConclusionsThere is a significant difference in the pattern of practice for NSCLC patients between radiation oncologists from China and the US. Fewer Chinese physicians selected larger fraction size for stereotactic RT, higher total dose for fractionated RT, and concurrent chemoradiation for stage II/III NSCLC, and aggressive RT for stage IV diseases. Purpose/Objective(s)To study the pattern of practice in radiation therapy (RT) for NSCLC patients in China and compare the results with that of US. To study the pattern of practice in radiation therapy (RT) for NSCLC patients in China and compare the results with that of US. Materials/MethodsStudy questionnaires were designed by a panel of 8 Board certified radiation oncologists. The survey was sent through email to radiation oncologist members of American Society of Therapeutic Radiology and Oncology (ASTRO) in September, 2006, and to Chinese radiation oncologists in January, 2007. The results were collected online in March, 2007. There were a total of 492 responses: 425 from the US and 67 from China. Study questionnaires were designed by a panel of 8 Board certified radiation oncologists. The survey was sent through email to radiation oncologist members of American Society of Therapeutic Radiology and Oncology (ASTRO) in September, 2006, and to Chinese radiation oncologists in January, 2007. The results were collected online in March, 2007. There were a total of 492 responses: 425 from the US and 67 from China. ResultsChinese respondents saw an average of 14 new cases monthly, significantly more than US physicians (p < 0.001). The choices of treatment decision and RT prescription were heterogeneous among respondents. There was a significant difference in choices of radiation regimens for stage I peripherally located disease: 20% Chinese vs 34% of US chose conventional fractionated RT (p < 0.00), 43% Chinese vs 19% of US chose stereotactic RT (p < 0.001), 0% Chinese vs 14% of US chose stereotactic RT 18-20 Gy × 3, and 23% Chinese vs 1.5% of US chose 6 Gy ×10 (p < 0.001). For stage I centrally located disease, the majority of respondents selected conventional fractionated RT in both countries: 28% of Chinese vs 8% of US chose stereotactic RT (p < 0.001). For stage II disease, a majority of respondents chose concurrent chemoradiation (64% Chinese vs 85% of US, p < 0.001), with radiation dose of 60–70 Gy in 1.8–2 Gy daily fractions (79% of US vs 69% Chinese). For stage III patients with a performance score of 70–100%, the dominant pattern of practice was concurrent chemoradiation followed by adjuvant chemotherapy (61% Chinese vs 85% of US respondents, p < 0.001); 16% Chinese vs 1% of US chose sequential chemoradiation (p < 0.001). For patients with performance score of 50–60%, 36% of Chinese and 41% of US respondents chose fractionated RT alone, 0% Chinese vs 11% of US chose concurrent chemoradiation followed by adjuvant chemotherapy, 22% Chinese vs 17% of US chose chemotherapy followed by RT, 13% Chinese vs 20% of US chose RT followed by chemotherapy (p < 0.001). Regarding choices of dose fractionation, 45% Chinese vs 79% of US respondents (p < 0.001) chose 60–70 Gy in 1.8–2 Gy daily fractions, 48% Chinese vs 13% of US chose exactly 60 Gy in 2 Gy daily fractions (p < 0.001). For stage IV disease with good performance score, 50% Chinese 27% of US respondents chose 2 Gy × 30 (p = 0.001), fewer Chinese respondents chose lower doses or no radiation (p = 0.001). For patients with stage IV with hemoptysis or obstructive lung disease with asymptomatic distant metastasis, Chinese respondents tended to choose chemotherapy followed by RT (39%) more than 3 Gy ×10 followed by chemotherapy (10%), which is the opposite of respondents of the US (5% vs 43%, p < 0.001). Chinese respondents saw an average of 14 new cases monthly, significantly more than US physicians (p < 0.001). The choices of treatment decision and RT prescription were heterogeneous among respondents. There was a significant difference in choices of radiation regimens for stage I peripherally located disease: 20% Chinese vs 34% of US chose conventional fractionated RT (p < 0.00), 43% Chinese vs 19% of US chose stereotactic RT (p < 0.001), 0% Chinese vs 14% of US chose stereotactic RT 18-20 Gy × 3, and 23% Chinese vs 1.5% of US chose 6 Gy ×10 (p < 0.001). For stage I centrally located disease, the majority of respondents selected conventional fractionated RT in both countries: 28% of Chinese vs 8% of US chose stereotactic RT (p < 0.001). For stage II disease, a majority of respondents chose concurrent chemoradiation (64% Chinese vs 85% of US, p < 0.001), with radiation dose of 60–70 Gy in 1.8–2 Gy daily fractions (79% of US vs 69% Chinese). For stage III patients with a performance score of 70–100%, the dominant pattern of practice was concurrent chemoradiation followed by adjuvant chemotherapy (61% Chinese vs 85% of US respondents, p < 0.001); 16% Chinese vs 1% of US chose sequential chemoradiation (p < 0.001). For patients with performance score of 50–60%, 36% of Chinese and 41% of US respondents chose fractionated RT alone, 0% Chinese vs 11% of US chose concurrent chemoradiation followed by adjuvant chemotherapy, 22% Chinese vs 17% of US chose chemotherapy followed by RT, 13% Chinese vs 20% of US chose RT followed by chemotherapy (p < 0.001). Regarding choices of dose fractionation, 45% Chinese vs 79% of US respondents (p < 0.001) chose 60–70 Gy in 1.8–2 Gy daily fractions, 48% Chinese vs 13% of US chose exactly 60 Gy in 2 Gy daily fractions (p < 0.001). For stage IV disease with good performance score, 50% Chinese 27% of US respondents chose 2 Gy × 30 (p = 0.001), fewer Chinese respondents chose lower doses or no radiation (p = 0.001). For patients with stage IV with hemoptysis or obstructive lung disease with asymptomatic distant metastasis, Chinese respondents tended to choose chemotherapy followed by RT (39%) more than 3 Gy ×10 followed by chemotherapy (10%), which is the opposite of respondents of the US (5% vs 43%, p < 0.001). ConclusionsThere is a significant difference in the pattern of practice for NSCLC patients between radiation oncologists from China and the US. Fewer Chinese physicians selected larger fraction size for stereotactic RT, higher total dose for fractionated RT, and concurrent chemoradiation for stage II/III NSCLC, and aggressive RT for stage IV diseases. There is a significant difference in the pattern of practice for NSCLC patients between radiation oncologists from China and the US. Fewer Chinese physicians selected larger fraction size for stereotactic RT, higher total dose for fractionated RT, and concurrent chemoradiation for stage II/III NSCLC, and aggressive RT for stage IV diseases.