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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Oncol. | doi: 10.3389/fonc.2019.00786

Trends of postoperative radiotherapy for completely resected non-small cell lung cancer in China: a hospital-based multicenter 10-year (2005-2014) retrospective clinical epidemiological study

 Yu Men1,  Le Wang1, 2, Ye Zhang1, 3, Shugeng Gao1, 4, Junling Li1, 5, Ning Wu1, 6, Boyan Yang1, 7, Shangmei Liu1, 8, Jiansong Ren1, 2,  Yunchao Huang9, Debin Wang10, Xianzhen Liao11, Xiaojing Xing12, Lingbin Du13, Li Yang14, Yuqin Liu15, Yongzhen Zhang16, Donghua Wei17, Yunyong Liu12,  Kai Zhang1, 18,  Youlin Qiao1, 19,  Jufang Shi1, 2*, Wanqing Chen1, 2, Min Dai1, 2* and  Zhouguang Hui1*
  • 1Department of VIP Medical Services, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 2Office of Cancer Screening, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 3Department of Radiation Oncology, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 4Department of Thoracic Surgery, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 5Department of Medical Oncology, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 6Department of Diagnostic Radiology, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 7Department of General Medicine, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 8Department of Pathology, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 9Yunnan Cancer Hospital and The Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Center, China
  • 10School of Health Services Management, Anhui Medical University, China
  • 11Hunan Office for Cancer Control and Research, Hunan Cancer Hospital, China
  • 12Liaoning Office for Cancer Control and Research, Liaoning Cancer Hospital, Cancer Hospital of China Medical University, China
  • 13Zhejiang Office for Cancer Control and Research, Zhejiang Cancer Hospital, China
  • 14School of Public Health, Guangxi Medical University, China
  • 15Cancer Epidemiology Research Center, Gansu Provincial Cancer Hospital Gansu Provincial Academic Instiute for Medical Research, China
  • 16Department of Epidemiology, Shanxi Provincial Cancer Hospital, China
  • 17Cancer Department of Physical Examination, Anhui Provincial Cancer Hospital, China
  • 18Cancer Department of Physical Examination, National Cancer Center, Chinese Academy of Medical Sciences, China
  • 19Department of Epidemiology, National Cancer Center, Chinese Academy of Medical Sciences, China

Objectives: The role of postoperative radiotherapy (PORT) in the treatment of patients with completely resected non-small cell lung cancer (NSCLC) is not clear. Few study explored the trends of the PORT use. In this study, we examine the status of PORT use of completely resected NSCLC in mainland China.
Methods: From 2005 to 2014, patients with primary lung cancer from eight hospitals across seven geographic regions of mainland China were selected. Then patients with staged Ⅰ-ⅢA NSCLC receiving radical surgery were enrolled in this study. The chi-square test was used to compare differences in the use of PORT among the groups of different age, regions and stages. The Cochran-Armitage trend test was used to identify the trend in the PORT use from 2005 to 2014.
Results: Totally, 2253 out of 7184 patients were with staged Ⅰ-ⅢA NSCLC receiving completely resection. Only 122 patients (5.42%) received PORT. During this decade, the use of PORT declined significantly (p=0.0002). In high socio-economic areas, the percentage of PORT use was 7.43%, which was significantly higher than 1.34% in the low socio-economic areas (p<0.0001). Age was also associated with PORT use (p=0.0747). For N-1 and N2 NSCLC, the proportions of PORT use were 4.01% and 10.22%, respectively (p<0.0001). And in N0-1 or N2 NSCLC, the proportions both decreased significantly during this decade (p=0.009 and 0.026, respectively). For stage Ⅰ, ⅡA, ⅡB and ⅢA, the proportions who received PORT were 2.59%, 4.65%, 5.49%, and 10.29%, respectively (p<0.0001). Modern radiation techniques were widely used, but the volumes and doses varied widely. The proportions of using IMRT and EPID/IGRT increased after 2012.
Conclusions: In China, the use of PORT was less than developed countries and had a declined trend. The use of PORT was related to disease stages, patients’ age and geographic location. Both in N0-1 and N2 diseases, the use of PORT declined. Proper education of radiation doctors was urgently needed.

Keywords: NSCLC, Postoperative radiotherapy, trend, Epidemiology, multicenter

Received: 04 Jan 2019; Accepted: 05 Aug 2019.

Edited by:

Jerry Polesel, Centro di Riferimento Oncologico di Aviano (IRCCS), Italy

Reviewed by:

Sha Tao, Shanghai Roche Pharmaceutical Co., Ltd, China
Hao Liu, Nanfang Hospital, Southern Medical University, China  

Copyright: © 2019 Men, Wang, Zhang, Gao, Li, Wu, Yang, Liu, Ren, Huang, Wang, Liao, Xing, Du, Yang, Liu, Zhang, Wei, Liu, Zhang, Qiao, Shi, Chen, Dai and Hui. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Prof. Jufang Shi, National Cancer Center, Chinese Academy of Medical Sciences, Office of Cancer Screening, Beijing, China, shijf@cicams.ac.cn
Prof. Min Dai, National Cancer Center, Chinese Academy of Medical Sciences, Office of Cancer Screening, Beijing, China, daimin2002@hotmail.com
Prof. Zhouguang Hui, National Cancer Center, Chinese Academy of Medical Sciences, Department of VIP Medical Services, Beijing, China, drhuizg@163.com