Mathijs L Tomassen1, Mieke J Aarts2, Max Peters1, Anne van Lindert3, Dirk K M De Ruysscher4, Joost J C Verhoeff1, Peter S N van Rossum1. 1. Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands. 2. Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands. 3. Department of Pulmonology, University Medical Center Utrecht, The Netherlands. 4. Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Abstract
INTRODUCTION: Controversy has arisen regarding the benefit of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC), particularly since the 2017 Takahashi trial publication that supports MRI surveillance in extensive-stage (ES-)SCLC. The primary aim of this study was to assess trends and determinants in PCI use over the years 2010-2018. A secondary aim was to determine contemporary practice considerations among radiation oncologists (ROs). METHODS: A nationwide population-based cohort study was conducted using the Netherlands Cancer Registry data on all newly diagnosed SCLC patients (2010-2018). The change in PCI frequency over the years and determinants for PCI were analyzed using logistic regression models. Second, an online survey was performed among Dutch lung cancer ROs in 2020. RESULTS: Among 10,264 eligible patients, 4,894 (47%) received PCI. Compared to 2010-2014, PCI use significantly decreased in 2017-2018 in ES-SCLC (OR 0.68, 95%CI 0.60-0.77) and LS-SCLC (OR 0.56, 95%CI 0.47-0.67). Incidence year, age, performance status, and thoracic radiotherapy were independent determinants for PCI. Among 41 survey participants, PCI was recommended always/sometimes/never by 22%/71%/7% in ES-SCLC and 54%/44%/2% in LS-SCLC. For ES-SCLC and LS-SCLC, 63% and 25% of ROs, respectively, confirmed influence of the Takahashi trial on PCI recommendations. Denial of such influence was associated with insufficient institutional MRI capacity. CONCLUSIONS: A significant declining trend of PCI use in both ES-SCLC and LS-SCLC was observed in The Netherlands since 2017. The Takahashi trial seems an explanation for this trend even in LS-SCLC, with differential influence of the trial depending on institutional MRI capacity. An alarming increase in practice variation regarding PCI was found which stresses the importance of ongoing trials.
INTRODUCTION: Controversy has arisen regarding the benefit of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC), particularly since the 2017 Takahashi trial publication that supports MRI surveillance in extensive-stage (ES-)SCLC. The primary aim of this study was to assess trends and determinants in PCI use over the years 2010-2018. A secondary aim was to determine contemporary practice considerations among radiation oncologists (ROs). METHODS: A nationwide population-based cohort study was conducted using the Netherlands Cancer Registry data on all newly diagnosed SCLC patients (2010-2018). The change in PCI frequency over the years and determinants for PCI were analyzed using logistic regression models. Second, an online survey was performed among Dutch lung cancer ROs in 2020. RESULTS: Among 10,264 eligible patients, 4,894 (47%) received PCI. Compared to 2010-2014, PCI use significantly decreased in 2017-2018 in ES-SCLC (OR 0.68, 95%CI 0.60-0.77) and LS-SCLC (OR 0.56, 95%CI 0.47-0.67). Incidence year, age, performance status, and thoracic radiotherapy were independent determinants for PCI. Among 41 survey participants, PCI was recommended always/sometimes/never by 22%/71%/7% in ES-SCLC and 54%/44%/2% in LS-SCLC. For ES-SCLC and LS-SCLC, 63% and 25% of ROs, respectively, confirmed influence of the Takahashi trial on PCI recommendations. Denial of such influence was associated with insufficient institutional MRI capacity. CONCLUSIONS: A significant declining trend of PCI use in both ES-SCLC and LS-SCLC was observed in The Netherlands since 2017. The Takahashi trial seems an explanation for this trend even in LS-SCLC, with differential influence of the trial depending on institutional MRI capacity. An alarming increase in practice variation regarding PCI was found which stresses the importance of ongoing trials.
Authors: D De Ruysscher; B Lueza; C Le Péchoux; D H Johnson; M O'Brien; N Murray; S Spiro; X Wang; M Takada; B Lebeau; W Blackstock; D Skarlos; P Baas; H Choy; A Price; L Seymour; R Arriagada; J-P Pignon Journal: Ann Oncol Date: 2016-07-19 Impact factor: 32.976
Authors: Ben J Slotman; Harm van Tinteren; John O Praag; Joost L Knegjens; Sherif Y El Sharouni; Matthew Hatton; Astrid Keijser; Corinne Faivre-Finn; Suresh Senan Journal: Lancet Date: 2014-09-14 Impact factor: 79.321
Authors: Olsi Gjyshi; Ethan B Ludmir; Todd A Pezzi; David Boyce-Fappiano; Amy E Dursteler; Timur Mitin; Steven H Lin Journal: JAMA Netw Open Date: 2019-08-02
Authors: Mathijs L Tomassen; Jacquelien Pomp; Janneke van der Stap; Anne S R van Lindert; Max Peters; José S A Belderbos; Dirk K M De Ruysscher; Steven H Lin; Joost J C Verhoeff; Peter S N van Rossum Journal: Clin Transl Radiat Oncol Date: 2022-02-17