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J.D. Ruben
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-043 - Lung Cancer Radiotherapy - Current Patterns of Practice in Australia and New Zealand (ID 801)
09:30 - 17:00 | Author(s): J.D. Ruben
- Abstract
Background:
The RANZCR Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) surveyed patterns of lung cancer radiotherapy practice in Australasia for both non-small cell (NSCLC)and small cell lung (SCLC) cancer to evaluate current patterns of care and define gaps in optimal care requiring improvement.
Methods:
Radiation Oncologists were surveyed at all 62 departments in Australasia using a web-based survey targeting those treating lung cancer. Questions covered current radiotherapy practice as well as measures of quality
Results:
Of 62 responses received, 57 did treat lung cancer and were eligible for analysis. All Australian states and New Zealand were represented. Sixty-two percent of respondents worked at metropolitan centres, 58% were subspecialists in lung cancer and 60% participate in lung cancer trials. Ninety-four percent discuss lung cancer patients at a tumour board, 74% peer review contours for conventional fractionation and 50% for SABR. Fifty percent used a department protocol for contouring and/or prescription, 39%, an external protocol and 11% had no protocol. For radical conventional radiotherapy, 58% use 4DCT to assess tumour motion, 44% utilise breath hold or respiratory gating, 44% use PET Fusion, 35%, free-breathing CT and 23% PET-CT simulation. In palliative settings, free-breathing CT was most common (81%). For conventional treatment, 98% use 3DCRT, 34% IMRT and 18% VMAT. Image verification was primarily with cone beam CT (86%), KV imaging (72%) and MV imaging (30%). The commonest dose fractionation regime in NSCLC was 60Gy in 30 fractions used in 95% of node-positive and 82% of node-negative disease. 66Gy in 33 fractions and 50-55Gy in 20 had been used by 32% and 30%of respondents respectively. 30Gy/10 fractions was the most frequent palliative regime that had been used (by 76%), followed by 36Gy/12 (72%) . For limited stage SCLC, the majority (61%) treated with 45-50.4Gy in 25-28 fractions while 45Gy/30 twice daily had been used by 48%. In extensive stage SCLC, consolidation chest radiotherapy was used by 63% in complete response, 48% for partial response and 24% would not treat. 46% of departments provided SABR but only half treated central tumours. For peripheral tumours, 80% used 54Gy in 3 fractions and if close to chest wall, 70% used 48Gy in 4 fractions. In fit patients with synchronous solitary brain metastasis and controlled extra-thoracic disease, 37% of respondents would treat both chest and brain definitively, 43% would do so only if chest disease was equivalent to Stage I/II, and 9% would never treat radically. If three brain metastases were present, just 46% would treat definitively. In the setting of an isolated systemic metastasis only, 35% would treat definitively while 61% do not offer definitive treatment in the setting of systemic oligo-metastases.
Conclusion:
A significant proportion of radiation oncologists did not have access to 4DCT for simulation. The majority used 3D image verification and consistently prescribed evidence-based doses. Although protocols were widely used, a significant number did not participate in peer review of contours. The treatment of synchronous oligo-metastatic disease was variable, likely due to a lack of high quality evidence and should be an area of future research.
