Abstract
Recent studies have suggested a significant variation in radiotherapy schedules used to treat advanced NSCLC, both between different centers as well as between countries. The purpose of this study is to investigate the range of treatment strategies for advanced NSCLC within Europe. In this study, treatment methodologies have been explored using management plans proposed by radiation oncologists regarding given general questions and theoretical case histories for patients with advanced NSCLC. A postal questionnaire was sent to twenty radiotherapy centers in Europe. The questionnaire consisted of two parts. The first part asked for reasons for starting radiotherapy, parameters that influenced the choice of total dose and fractionation and the kind of equipment that was used. The second part presented five case histories asking the responders about the management of these five theoretical patients and regarding the radiotherapy techniques proposed and the aim of treatment. Seventy percent of the centers replied. The responders suggested that the most important factors, which influence the choice of total dose and fractionation schedule, are distant metastases (100%), patients' performance status (100%), lung function (90%) and size of the primary tumor (81%). Less important factors are gender (8%) and histology (43 %). The most common reasons for starting the treatment is not only symptom relief, but also cure. More than 95 % of the responders replied that they would give radiotherapy in all five cases. The median total doses proposed where 20 Gy/5 fractions/1 week or 30 Gy/10 fractions/2weeks for the cases A and D (equivalent dose for fractionation of 2 Gy per fraction = 23 and 33 Gy) and 60 Gy/30 fractions/6weeks or 68 Gy/34 fractions/7weeks for the cases B, C and E. For the case E, 20% of the responders suggested Stereotactic Body Radiotherapy with 63 Gy in 3 fractions. This survey demonstrates a range of treatment strategies for advanced NSCLC within Europe. Influential factors in this study included the perceived aims of treatment and the estimated prognosis of the patient. Those aiming to extent life would give significantly higher total doses in a larger number of fractions, whereas those aiming to relieve symptoms would give significantly lower total doses. These factors should be taken into account when evaluating the effectiveness of different irradiation.
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