NASHVILLE--Medical and radiation oncologists have distinctly
different views on how best to treat non-small-cell lung cancer
(NSCLC), results of a nationwide survey suggest.
The two specialties disagree on the appropriate application of
chemotherapy vs radiation therapy and on the use of combination
chemoradiotherapy. Moreover, physician specialty and training era
dictate preferences for chemotherapy regimens, Hak Choy, MD, reported
at an ASCO poster session.
The findings point to a need to reconcile the information reported in
the literature of the two specialties and presented at continuing
education programs, said Dr. Choy, associate professor of radiation
oncology, Vanderbilt University.
"Two factors clearly influence the choice of therapy for NSCLC:
whether the physician is a medical oncologist or radiation oncologist
and the year the physician began practicing medicine," he said.
"Instead, choices should reflect current standards of care."
These conclusions come from responses to a nationwide survey that
included 492 medical oncologists and 455 radiation oncologists. Most
of the respondents (679) completed their medical training prior to
1980 or between 1980 and 1989. More than half (524) said they see
between 20 and 50 newly diagnosed lung cancer patients each year.
Overall, 55% of oncologists said they base their treatment decisions
on information from the medical literature. However, the proportion
of physicians relying primarily on the medical literature ranged from
48% of those who completed training before 1980 to 70% of those who
finished after 1995.
Similarly, the proportion of oncologists who said they rely primarily
on personal experience for treatment choices declined from 22% of
physicians who completed training before 1980 to 11% to 13% for those
who finished after 1990.
Specialty and age figured prominently in the physicians choices
for adjuvant therapy after surgery for T1-3, N1-2 cancer (see Table).
More medical oncologists (25%) than radiation oncologists (5%) said
that no further therapy is required after surgery.
About 55% of the radiation oncologists recommended mediastinal
radiation after surgery, while almost 38% preferred
chemoradiotherapy, as did about half the medical oncologists.
When the responses were evaluated by training years, 51% of the
pre-1980 group preferred chemoradiotherapy vs 33% of the oncologists
who finished training between 1990 and 1994 and 39% of those who
finished in 1995 or later. About 42% of the oncologists who completed
training more recently said they favor mediastinal radiotherapy as
the sole adjuvant therapy after surgery.
When combined chemoradiation therapy is contemplated, about a third
of physicians in both specialties said they recommend concurrent
chemotherapy with radiation. About another third expressed a
preference for induction chemotherapy with radiation. The preferences
were fairly similar across all years of training.
Physicians who completed their training in 1995 or later preferred
etoposide (VePesid) and a platinum compound (52.5%) as first-line
chemotherapy for combined modality treatment of nonmetastatic NSCLC.
In contrast, oncologists who completed training prior to 1980
preferred the combination of paclitaxel (Taxol) and carboplatin
(Paraplatin) (50.2% vs 28.3% of physicians who began practicing in
1995 or later).
Specialty figured prominently in chemotherapy preferences for
symptomatic, metastatic lung cancer. Most medical oncologists (58%)
recommend the combination of paclitaxel and carboplatin, compared
with 30% of radiation oncologists. About 38% of radiation oncologists
prefer etoposide-cisplatin, as opposed to fewer than 10% of the
Medical oncologists are more likely to consider chemotherapy
appropriate for patients who have poor performance status (30% vs 17%
of radiation oncologists). The specialty-specific preference was
apparent across the spectrum of training eras.
"Medical oncologists and radiation oncologists need to be closer
in their views because combined modalities are becoming more
important in the treatment of many lung cancers, actually all types
of tumors," Dr. Choy said. "There are efforts being made to
try to bring oncologists in the different specialties together,
including large symposia."