The management of lung cancer: a UK survey of oncologists

Our plain-English summary of The management of lung cancer: a UK survey of oncologists, by S.L. Prewett, S. Aslam, M.V. Williams, et al (Clinical Oncology, 2012).

The study

• Authors: S.L. Prewett, S. Aslam, M.V. Williams, D. Gilligan
• Journal: Clinical Oncology
• Published: 2012;24(6):402-9
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: This report reviews current radiotherapy practice across the UK in the management of lung cancer, and the way new treatments and technologies are being introduced, where improvements have occurred, and where work is still required. We wanted to determine adherence to both National Radiotherapy Advisory Group and National Institute for Health and Clinical Excellence (NICE) guidance. This survey was conducted on behalf of the Department of Health Lung Cancer & Mesothelioma Advisory Group.

Materials And Methods: We sent a questionnaire to all UK radiotherapy departments. It covered radical radiotherapy dose fractionation, the use of concurrent or sequential chemotherapy for both non-small cell and small cell lung cancers, the use of continuous hyperfractionated accelerated radiotherapy, new radiotherapy techniques, the use of positron emission tomography/computed tomography for planning purposes and patient accrual into current National Cancer Research Network UK trials.

Results: This UK-wide survey of radiotherapy practice for lung cancer showed broad compliance with NICE clinical guidance, but highlighted significant variation in fractionation schedules and the use of concomitant chemoradiotherapy. Clinical trial entry into lung cancer radiotherapy trials was variable and many centres are not fully participating in recruitment into these trials.

Conclusions: This report has shown the variability of radiotherapy provision nationally. Current practice is largely consistent with current and updated NICE recommendations and best practice and should be recognised as such. It has also highlighted areas where improvements are still needed, particularly fractionation and new technologies. One particular aspect of concern is the poor recruitment to current UK-based clinical trials in lung cancer.

Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

In plain English

This was a questionnaire survey of radiotherapy practice for lung cancer across the UK. It was not a study of asbestos exposure or of mesothelioma. Questionnaires went to lung cancer lead clinicians at UK radiotherapy departments in 2010, and 50 of 55 centres (91%) responded. The survey asked about radiotherapy doses and schedules, chemotherapy given with radiotherapy, newer techniques, PET/CT scans for planning, and recruitment to national trials. For non-small cell lung cancer, all centres except one (98%) offered a schedule consistent with NICE guidance, most often 55 Gy in 20 fractions over 4 weeks. Fourteen of 50 centres (28%) offered CHART, and 36 of 50 (72%) offered chemotherapy and radiotherapy together. For limited stage small cell lung cancer, 42 of 50 centres (84%) gave chemotherapy alongside radiation. Forty-five centres (90%) always used PET/CT for patients treated with radical intent, and 37 (74%) were recruiting to national lung radiotherapy trials. The authors concluded that practice was largely consistent with NICE guidance but varied, and that poor trial recruitment was a particular concern.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: questionnaire survey of radiotherapy departments
• Who was studied: lung cancer lead clinicians at UK radiotherapy centres, contacted in 2010; 55 centres were identified and 50 responded (43 of 46 in England, 5 of 5 in Scotland, 2 of 3 in Wales, 0 of 1 in Northern Ireland)
• Main results:
  • 50 of 55 UK radiotherapy centres (91%) responded to the survey
  • For non-small cell lung cancer, all centres except one (98%) offered a radical schedule consistent with NICE guidance; the most common was 55 Gy in 20 fractions over 4 weeks
  • 14 of 50 centres (28%) offered CHART (continuous hyperfractionated accelerated radiotherapy) for non-small cell lung cancer
  • 36 of 50 centres (72%) offered concurrent chemoradiation for non-small cell lung cancer, one of them only rarely; 27 of 50 (54%) said it was their default standard of care
  • For limited stage small cell lung cancer, 42 of 50 centres (84%) used chemotherapy at the same time as radiation, and most of these (33 of 42) started radiotherapy with the second chemotherapy cycle
  • 25 Gy in 10 fractions was the most common prophylactic cranial irradiation dose for limited stage small cell lung cancer (70% of centres)
  • 45 centres (90%) always used PET/CT scans for patients treated with radical intent; 5 centres (10%) did not
  • 37 centres (74%) were actively recruiting to national (NCRN) lung cancer radiotherapy trials, so 26% were not enrolling to any of the three trials asked about
  • 44% of centres named lack of physicist time, radiographer shortages, lack of oncologist time, lack of equipment and funding as barriers
• The authors' conclusion: The authors concluded that radiotherapy provision varied across the UK. They found practice largely consistent with NICE recommendations and best practice, but said improvements were still needed, particularly in fractionation and new technologies. They identified poor recruitment to UK lung cancer trials as a particular concern.
• Limitations the authors state:
  • The survey did not specifically ask about thoracic radiotherapy, or its timing, in extensive stage small cell lung cancer

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma, Chemotherapy, Small Cell Lung Cancer, Clinical Trial.

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