Current practice when treating lung cancer in Australasia

European Organisation for Research and Treatment of Cancer Recommendations for Planning and Delivery of High-Dose, High-Precision Radiotherapy for Lung Cancer

Purpose

To derive recommendations for routine practice and clinical trials for techniques used in high-dose, high-precision thoracic radiotherapy for lung cancer.

Methods

A literature search was performed to identify published articles considered both clinically relevant and practical to use. Recommendations were categorized under the following headings: patient selection, patient positioning and immobilization, tumor motion, computed tomography and [18F]fluorodeoxyglucose–positron emission technology scanning, generating target volumes, radiotherapy treatment planning, treatment delivery, and scoring of response and toxicity. The American College of Chest Physicians grading of recommendations was used.

Results

Recommendations were identified for each of the recommendation categories. Although most of the recommended techniques have not been evaluated in multicenter clinical trials, their use in high-precision thoracic radiotherapy and stereotactic body radiotherapy (SBRT) appears to be justified on the basis of available evidence.

Conclusion

Recommendations to facilitate the clinical implementation of high-precision conformal radiotherapy and SBRT for lung tumors were identified from the literature. Some techniques that are considered investigational at present were also highlighted.

Frontiers of cancer care in Asia-Pacific region: cancer care in Australia

Cancer has a significant impact on the Australian community. One in three men and one in four women will develop cancer by the age of 75. The estimated annual health expenditure due to cancer in 2000-1 in Australia was $2.7 billion, representing 5.5% of the country’s total healthcare expenditure. An historical overview of the national cancer control strategies in Australia is provided. In males, the five most common cancers in order of decreasing incidence are: prostate cancer, colorectal cancer, lung cancer, melanoma and lymphoma, while for Australian women, breast cancer is the most common cancer. Key epidemiologic information about these common cancers, current management issues and comprehensive national clinical practice guidelines (where available) are highlighted. Aspects of skin cancer, a particularly common cancer in the Australian environment – with a focus on melanoma – are also included.

Cancer outcomes in Australia, measured by selected outcomes, are among the best in the world. However, there is still evidence of health inequalities, especially among patients residing in regional and remote areas, the indigenous population and people from lower socio-economic classes. Limitations of current cancer care practices in Australia, including provision of oncology services, resources and other access issues, as well as suggested improvements for future cancer care, are summarised. Ongoing implementation of national and state cancer control plans and evaluation of their effectiveness will be needed to pursue the goal of optimal cancer care in Australia.