PDF(Pubmed)
Abstract：
Concurrent chemoradiotherapy (CRT) is the standard of care for limited-stage small cell lung cancer (LS-SCLC). Local therapy-surgery or stereotactic body radiotherapy (SBRT)-with adjuvant chemotherapy may be appropriate for very early (T1-T2, N0) disease. There is variability in the management of these cases, which may lead to variability in patient outcomes. This study aimed to determine practice patterns for the management of very early LS-SCLC in Canada. A survey was developed and distributed to Canadian medical and radiation oncologists specialising in lung cancer. The survey consisted of three sections: (1) physician demographics, (2) general practice approach, and (3) preferred approach for three clinical scenarios (1: peripheral T1 lesion; 2: central T1 lesion; 3: peripheral T2 lesion). Responses were analysed to detect differences across cases and among physician groups. There were 77 respondents. In case 1, assuming medical operability, most respondents (73%) chose surgery and adjuvant chemotherapy, with 19% choosing CRT. CRT was selected by a higher proportion in case 2 (48%) and case 3 (61%) (p < 0.05). If medically inoperable, most chose CRT over local therapy in all cases, with more choosing CRT in case 2 (84%) and case 3 (86%) than in case 1 (55%) (p < 0.05). Subgroup analysis showed a predilection towards CRT in Western Canada and among more experienced physicians, and towards SBRT in Ontario. There is variability in the management of very early LS-SCLC in Canada. CRT remains the most popular strategy in most cases, with surgery preferred for small peripheral lesions. Larger and more central tumours are more likely to be managed with CRT. Variation in practice is correlated with region and physician experience. Our study illustrates the variability in the management of very early LS-SCLC in Canada and highlights the need for more robust investigations into the ideal approach for these patients.
摘要：
同步放化疗（CRT）是局限期小细胞肺癌（LS-SCLC）的标准治疗方法。局部治疗-手术或立体定向放疗（SBRT）-辅助化疗可能适用于非常早期（T1-T2，N0）疾病。这些案件的管理存在差异，这可能导致患者预后的变异性。本研究旨在确定加拿大早期LS-SCLC管理的实践模式。制定了一项调查，并分发给专门研究肺癌的加拿大医学和放射肿瘤学家。调查包括三个部分：(1)医生人口统计，(2)一般实践方法，和（3）三种临床情况的首选方法（1：外周T1病变；2：中央T1病变；3：外周T2病变）。对反应进行了分析，以检测不同病例和医生组之间的差异。有77名受访者。在情况1中，假设医疗可操作性，大多数受访者(73%)选择手术和辅助化疗，19%的人选择CRT。病例2(48%)和病例3(61%)选择CRT的比例较高(p<0.05)。如果医学上无法手术，在所有情况下，大多数人选择CRT而不是局部治疗，在病例2（84％）和病例3（86％）中选择CRT比病例1（55％）更多（p<0.05）。亚组分析显示，加拿大西部和更有经验的医生倾向于CRT，前往安大略省的SBRT。在加拿大，非常早期的LS-SCLC的管理存在差异。在大多数情况下，CRT仍然是最受欢迎的策略，对于小的周围病变，首选手术。更大和更多的中心肿瘤更有可能使用CRT进行管理。实践中的差异与地区和医师经验相关。我们的研究说明了加拿大非常早期的LS-SCLC管理的可变性，并强调需要对这些患者的理想方法进行更有力的调查。
