Jelle Evers1, Katrien de Jaeger2, Lizza E L Hendriks3, Maurice van der Sangen4, Chris Terhaard5, Sabine Siesling6, Dirk De Ruysscher7, Henk Struikmans8, Mieke J Aarts9. 1. Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Hallenweg 5, 7522 NH Enschede, the Netherlands. Electronic address: J.Evers@iknl.nl. 2. Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands. Electronic address: Katrien.d.Jaeger@catharinaziekenhuis.nl. 3. Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Pulmonary Diseases, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands. Electronic address: Lizza.Hendriks@mumc.nl. 4. Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands. Electronic address: Maurice.vd.Sangen@catharinaziekenhuis.nl. 5. Utrecht University Medical Center, Department of Radiation Oncology, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. Electronic address: C.H.J.Terhaard@umcutrecht.nl. 6. Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Hallenweg 5, 7522 NH Enschede, the Netherlands. Electronic address: S.Siesling@iknl.nl. 7. Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Doctor Tanslaan 12, 6229 ET Maastricht, the Netherlands. Electronic address: Dirk.DeRuysscher@maastro.nl. 8. Leiden University Medical Centre, Department of Radiation Oncology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. Electronic address: HStruikmans@ziggo.nl. 9. Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands. Electronic address: M.Aarts@iknl.nl.
Abstract
INTRODUCTION: This Dutch population-based study describes nationwide treatment patterns and its variations for stage I-III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Patients diagnosed with clinical stage I-III NSCLC in the period 2008-2018 were selected from the Netherlands Cancer Registry. Treatment trends were studied over time and age groups. Use of radiotherapy versus surgery (stage I-II), and concurrent versus sequential chemoradiotherapy (stage III) were analyzed by logistic regression. RESULTS: In stage I, the rate of surgery decreased from 58 % (2008) to 40 % (2018) while radiotherapy use increased over time (from 31 % to 52 %), which mostly concerned stereotactic body radiotherapy (74 %). In stage II, 54 % of patients received surgery, and use of radiotherapy alone increased from 18 % to 25 %. The strongest factors favoring radiotherapy over surgery were WHO performance status (OR ≥ 2 vs 0: 23.39 (95% CI: 18.93-28.90)), increasing age (OR ≥ 80 vs <60 years: 14.52 (95% CI: 13.02-16.18)) and stage (OR stage II vs I: 0.61 (95% CI: 0.57-0.65)). In stage III, the combined use of chemotherapy and radiotherapy increased from 35 % (2008) to 39 % (2018). In all years, 23 % received concurrent chemoradiotherapy, 9 % sequential chemoradiotherapy, 23 % radiotherapy or chemotherapy alone, and 25 % best supportive care. The strongest factors favoring concurrent over sequential chemoradiotherapy were age (OR ≥ 80 vs <60 years: 0.14 (95% CI: 0.10-0.19)), WHO Performance status (OR ≥ 2 vs 0: 0.33 (95% CI: 0.24-0.47)) and region (OR east vs north: 0.39 (95% CI: 0.30-0.50)). CONCLUSIONS: The use of radiotherapy became more prominent over time in stage I NSCLC. Combined use of chemotherapy and radiotherapy marginally increased in stage III: only one third of patients received chemoradiotherapy, mainly concurrently. Treatment variation seen between patient groups suggests tailored treatment decision, while variation between hospitals and regions indicate differences in clinical practice.
INTRODUCTION: This Dutch population-based study describes nationwide treatment patterns and its variations for stage I-III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS:Patients diagnosed with clinical stage I-III NSCLC in the period 2008-2018 were selected from the Netherlands Cancer Registry. Treatment trends were studied over time and age groups. Use of radiotherapy versus surgery (stage I-II), and concurrent versus sequential chemoradiotherapy (stage III) were analyzed by logistic regression. RESULTS: In stage I, the rate of surgery decreased from 58 % (2008) to 40 % (2018) while radiotherapy use increased over time (from 31 % to 52 %), which mostly concerned stereotactic body radiotherapy (74 %). In stage II, 54 % of patients received surgery, and use of radiotherapy alone increased from 18 % to 25 %. The strongest factors favoring radiotherapy over surgery were WHO performance status (OR ≥ 2 vs 0: 23.39 (95% CI: 18.93-28.90)), increasing age (OR ≥ 80 vs <60 years: 14.52 (95% CI: 13.02-16.18)) and stage (OR stage II vs I: 0.61 (95% CI: 0.57-0.65)). In stage III, the combined use of chemotherapy and radiotherapy increased from 35 % (2008) to 39 % (2018). In all years, 23 % received concurrent chemoradiotherapy, 9 % sequential chemoradiotherapy, 23 % radiotherapy or chemotherapy alone, and 25 % best supportive care. The strongest factors favoring concurrent over sequential chemoradiotherapy were age (OR ≥ 80 vs <60 years: 0.14 (95% CI: 0.10-0.19)), WHO Performance status (OR ≥ 2 vs 0: 0.33 (95% CI: 0.24-0.47)) and region (OR east vs north: 0.39 (95% CI: 0.30-0.50)). CONCLUSIONS: The use of radiotherapy became more prominent over time in stage I NSCLC. Combined use of chemotherapy and radiotherapy marginally increased in stage III: only one third of patients received chemoradiotherapy, mainly concurrently. Treatment variation seen between patient groups suggests tailored treatment decision, while variation between hospitals and regions indicate differences in clinical practice.
Authors: Daan C L Vessies; Milou M F Schuurbiers; Vincent van der Noort; Irene Schouten; Theodora C Linders; Mirthe Lanfermeijer; Kalpana L Ramkisoensing; Koen J Hartemink; Kim Monkhorst; Michel M van den Heuvel; Daan van den Broek Journal: Mol Oncol Date: 2022-06-27 Impact factor: 7.449
Authors: Isabel F Remmerts de Vries; Merle I Ronden; Idris Bahce; Femke O B Spoelstra; Patricia F De Haan; Cornelis J A Haasbeek; Birgit I Lissenberg-Witte; Ben J Slotman; Max Dahele; Wilko F A R Verbakel Journal: Cancers (Basel) Date: 2021-11-25 Impact factor: 6.639
Authors: Rianne D W Vaes; Kobe Reynders; Jenny Sprooten; Kathleen T Nevola; Kasper M A Rouschop; Marc Vooijs; Abhishek D Garg; Maarten Lambrecht; Lizza E L Hendriks; Marijana Rucevic; Dirk De Ruysscher Journal: Cancers (Basel) Date: 2021-12-13 Impact factor: 6.639