Treatment strategies for advanced and metastatic cancer

Summary ESTRO members were surveyed by questionnaires regarding the management of three cases of advanced cancer and the organisation of cancer care in their centre. There were 278 replies from within Europe from a total of 21 countries and 231 centres. The cases were a 64-year-old man with brain metastases from a small cell carcinoma of the lung, a 64-year-old woman with bone metastases from carcinoma of the breast on tamoxifen and a 59-year-old man with a squamous cell carcinoma (NSCLC) of the bronchus and positive mediastinal lymph nodes. Over 90~o of respondents replied that they would give radiotherapy in each of these cases. The median total doses were 30 Gy for the brain metastases, 30 Gy for the bony metastases and 56 Gy for the case of NSCLC. There was variation as to the perceived prognosis and appropriate aims of therapy, particularly for the case of NSCLC. The total dose and number of fractions of radiotherapy could be related to the perceived aims and expectations of treatment, e.g. those aiming to extend life gave signifieantly higher total doses of radiotherapy (p = 0.0001) and those aiming to relieve symptoms gave significantly lower total doses (p -- 0.0001). Treatment for this case was described as "radical" by 53 ~o of respondents and as "palliative" by 47~o and the prognosis was estimated to be less than 12 months by 41 ~o and 1-2 years by 44~o. Those describing treatment as radical and estimating longer survival gave higher doses and more fractions than those treating palliatively. There was also variation in the estimated total proportion of palliative patients seen in departments, e.g. while 27~o of respondents estimated this proportion to be less than 30~o, 20 To estimated it to be greater than 50~o. This survey demonstrates a wide range of treatment strategies for advanced cancers within Europe. Influential factors in this study included the perceived aims of treatment and the estimated prognosis of the patient. The organisation of the department may also be important, but this needs confirmation using a larger study of infrastructure of departments.