PURPOSE:To better define patterns of practice for patients with non-small cell lung cancer (NSCLC) in the United States. METHODS AND MATERIALS:A survey of 36 questions was designed to collect information regarding practice patterns of radiation oncologists for the management of patients with NSCLC. All American Society for Radiation Oncology members were invited to respond. RESULTS:Four hundred twenty-four responses from radiation oncologists in the United States were received. The response rate for the survey was approximately 20%. Substantial discrepancies were seen in the use of stereotactic body radiation therapy (SBRT) for patients with peripherally and centrally located early-stage tumors and in the recommended SBRT dose. There was a near consensus opinion regarding the use of concurrent chemotherapy and the radiation dose for patients with inoperable stage II and III NSCLC with a good performance status; however, in patients with a poor performance status or in patients with stage IV disease treatment recommendations differed remarkably. Additionally, the use of elective nodal irradiation and the assessment of tumor motion during simulation were highly variable. Thoracic radiation oncologists were more likely to prescribe higher doses, omit elective nodal irradiation, and use advanced technologies (P < .001). CONCLUSIONS:Substantial variations were seen in the management of patients with stage I and IV NSCLC in addition to the incorporation of new technology. This information can be used to help design meaningful clinical trials.

To compare outcomes for patients treated definitively with Intensity Modulated Radiotherapy (IMRT) versus Conventional Radiotherapy (CRT) for head and neck squamous cell carcinomas (HNSCC). We hypothesized that CRT, which uses multiple abutting fields in the neck, may yield inferior nodal dosimetry and regional control when compared to IMRT in patients with advanced nodal disease (N2c or N3). We conducted a matched cohort analysis of IMRT versus CRT for definitive treatment of HNSCC. One hundred ninety-two patients with HNSCC underwent definitive IMRT (n = 96) or CRT (n = 96) from 2000 to 2010. The two cohorts were matched for T stage, N stage, primary site, and smoking history. The following were similar between the two cohorts: those receiving platin-based chemotherapy (p = 0.38), race (p = 0.89), gender (p = 0.86), age (p = 0.50), and prescribed total dose (p = 0.75). The median follow-up for all patients was 34.4 months (range 4 to 120 months). Kaplan-Meier 2 year estimates of local control (LC), regional control (RC), freedom from distant metastasis (FFDM), cause specific survival (CSS), and overall survival (OS) were calculated and compared using log-rank tests. A subset analysis was performed for N2c and N3 patients. There were no differences between the two matched cohorts, IMRT vs. CRT, for 2-year endpoints of LC (74% vs. 78%, p = 0.50), RC (87% vs. 84%, p = 0.52), FFDM (77% vs. 76%, p = 0.95), CSS (74% vs. 69%, p = 0.26), or OS (72% vs. 63%, p = 0.08). When only analyzing patients with N2c and N3 disease, the RC for IMRT (N = 39) and CRT (N = 39) was 86% versus 70%, p = 0.15. We therein analyzed an unmatched cohort of all N2c or N3 patients treated from 2000 to 2010. Primary oral cavity and hypopharynx cancers were excluded as they were predominantly treated with CRT. This yielded 60 IMRT and 62 CRT patients. The median follow-up was 21.8 months. The 2-year RC for N2c, N3 patients was 81% vs. 58% (IMRT vs. CRT, p = 0.01). There was no statistical difference in the distribution of primary site (p = 0.59) or tumor stage (p = 0.91) in this unmatched comparison. Dosimetric statistics were available in 93/122 patients (76%); see Table 1. The use of IMRT does not appear to negatively affect patient outcomes when compared to CRT. IMRT may provide a RC benefit in patients with N2c or N3 disease which may be the result of the dosimetric advantages of IMRT.Table 1Dose Volume Statistics for Gross Nodal DiseaseDose Volume StatisticsIMRT (n = 54)CRT (n = 39)Median (range)Median (range)Dose at 95% of Volume6875 cGy (5350 - 7266)6365 cGy (4750 - 7300)% Volume receiving 100% Prescription Dose83% (1.2 - 100)71% (12.2 - 100)% Volume receiving 95% Prescription Dose99.9% (39.6 - 100)89.4% (48.3 - 100)% Volume receiving 90% Prescription Dose100% (82.1 - 100)96.1% (50.5 - 100) Open table in a new tab