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Facility-Level Disparities in Radiation Use for Limited-Stage Small Cell Lung Cancer.
Ian T Tsekouras1, Whitney S Hotsinpiller2, James A Bonner2
1Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
JCO Oncology Practice
|February 11, 2025
Summary
Nearly half of facilities do not use twice-daily radiation therapy for limited-stage small cell lung cancer, despite evidence of its effectiveness. Academic and high-volume centers are more likely to offer this superior treatment for LS-SCLC.
Area of Science:
- Radiation Oncology
- Thoracic Oncology
- Clinical Practice Patterns
Background:
- Twice-daily radiation therapy (RT) has been the standard for limited-stage small cell lung cancer (LS-SCLC) for decades.
- Evidence suggests dose-escalated twice-daily RT may improve outcomes, yet once-daily treatment remains common.
- Understanding facility utilization patterns of twice-daily RT is crucial for optimizing LS-SCLC treatment.
Purpose of the Study:
- To evaluate the utilization of twice-daily (BID) versus once-daily (QD) radiation therapy fractionation schedules in treatment facilities for LS-SCLC.
- To identify facility characteristics associated with the adoption of BID RT for LS-SCLC.
Main Methods:
- Retrospective analysis of LS-SCLC patients treated with definitive chemoradiation from 2004-2019 using the National Cancer Database.
- Classification of facilities as BID-treating (offering at least one BID course) or QD-only.
- Analysis of facility-level characteristics, including academic affiliation and patient volume, associated with QD-only classification.
Main Results:
- Of 1,222 facilities, 52.7% were BID-treating and 47.3% were QD-only.
- Academic facilities (73.9%) and high-volume facilities (78.2% in the highest quartile) were significantly more likely to use BID RT.
- Multivariable analysis confirmed academic and high-volume status were associated with BID-treating classification.
Conclusions:
- A significant proportion of facilities (47.3%) do not utilize twice-daily fractionation for LS-SCLC, despite evidence supporting its efficacy.
- High-volume and academic medical centers are more likely to offer twice-daily RT for LS-SCLC.
- This disparity highlights potential barriers to adopting evidence-based RT fractionation in LS-SCLC treatment.
