224 中国临床肿瘤学教育专辑 (2007)

    中国与美国非小细胞肺癌放射治疗模式的

    调查结果及临床证据基础

    中国医学科学院肿瘤医院放疗科 王绿化 Wang Li

    Differences in pattern of practice in radiation therapy for patients with non-small cell lung cancer

    between physicians in China and the United States

    Luhua Wang, Li Wang, Jianzhong Cao, Lujun Zhao, Xiaolong Fu, GuoLiang Jiang,Howard Sandler , Benjamin Movsas and Feng-Ming Kong

    Abstract Objective: Radiation therapy (RT) is the mainstay local treatment in patients with

    non-small cell lung cancer (NSCLC). Pattern of practice in radiation therapy and radiation techniques

    are very important to the treatment outcomes. The primary purpose of this study was to determine the

    pattern of practice whether there is a difference in practicing radiation therapy (RT) for NSCLC

    between radiation oncologists from China and the United States (US). Methods: Study questionnaires

    were designed by a panel of 8 American Board certified radiation oncologists. The survey was sent

    through email to radiation oncologist members of American Society of Therapeutic Radiology and

    Oncology (ASTRO) on September 10th

    2006. to January first 2007, with the results collected online on

    March 30th

    2007. There were a total of 492 responses for this analysis. Chi-square test was used to

    determine the significance in differences. Results: There were 425 responses from US and 67 from

    China that saw an average of new cases monthly 7.11 (range 0-40) vs 11.54 (range 1-90). There was

    significant difference in choices of radiation regimen for stage I peripherally located disease: 34.4% of

    US vs 20.0% from China selected conventional fractionated RT and 19.1% of US vs 43.1% from China

    selected stereotactic RT (P<0.001); 14.3% of US vs 0.0% from China chose stereotactic RT 18-20 Gy x

    3fractions and 1.5% of US vs 23.1% from China chose 6Gy x 10 fractions within 2 weeks (P<0.001).

    For stage I centrally located disease, the majority of respondents selected conventional fractionated RT

    in both country (64.3% of US vs 52.3% from China); only 7.7% of US chose stereotactic RT but 27.7%

    of China chose this regiment (P<0.001). The choices of fractionation scheme for stereotactic RT,16.9% of China selected 6Gy x10 within 2 weeks but only 1.3% from U.S chose it (P<0.001). For

    stage II disease, the dominant pattern of practice was concurrent chemoradiation (85.4% of US vs

    63.5% from China, P<0.001) and dose fractionation was 60-70 Gy in 1.8-2 Gy daily fractions (79.1%

    of US vs 68.8% from China). For stage III patients with performance score of 70-100%, the dominant

    pattern of practice was concurrent chemoradiation followed by adjuvant chemotherapy (85.2% from

    US vs 60.9% from China, P<0.001), however, 15.6% of China chose chemotherapy followed by RT

    but only 1.0% from US chose it (P<0.001); when performance score of 50-60%, the majority of

    respondents chose fractionated RT (41.3% of US vs 35.9% from China) (P<0.001), 11.2% of US vs

    0.0% from China chose concurrent chemoradiation followed by adjuvant chemotherapy, 19.8% of US

    vs 12.5% from China chose fractionated RT followed by chemotherapy (P<0.001). Regarding choices ......