Jelle Evers1, Lizza E L Hendriks2, Katrien De Jaeger3, Robin Wijsman4, Dirk De Ruysscher5, Chris Terhaard6, Maurice van der Sangen3, Sabine Siesling7, 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. Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Pulmonary Diseases, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. 3. Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. 4. University Medical Center Groningen, Department of Radiation Oncology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. 5. 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. 6. Utrecht University Medical Center, Department of Radiation Oncology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. 7. 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. 8. Leiden University Medical Centre, Department of Radiation Oncology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. 9. Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands.
Abstract
OBJECTIVES: Recent treatment patterns for small cell lung cancer (SCLC) in the Netherlands were unknown. This nationwide population-based study describes trends and variations in the treatment of stage I-III SCLC in the Netherlands over the period 2008-2019. MATERIALS AND METHODS: Patients were selected from the population-based Netherlands Cancer Registry. Treatments were studied stratified for clinical stage. In stage II-III, factors associated with the use of concurrent (cCRT) versus sequential chemoradiation (sCRT) and accelerated versus conventionally fractionated radiotherapy in the context of cCRT were identified. RESULTS: In stage I (N = 535), 29% of the patients underwent surgery in 2008-2009 which increased to 44% in 2018-2019. Combined use of chemotherapy and radiotherapy decreased in stage I from 47% to 15%, remained constant (64%) in stage II (N = 472), and increased from 57% (2008) to 70% (2019) in stage III (N = 5,571). Use of cCRT versus sCRT in stage II-III increased over time (odds ratio (OR) 2008-2011 vs 2016-2019: 0.53 (95%-confidence interval (95%CI): 0.41-0.69)) and was strongly associated with lower age, WHO performance status 0, and diagnosis in a hospital with in-house radiotherapy. Forty-six percent of patients with stage III received cCRT in 2019. Until 2012, concurrent radiotherapy was mainly conventionally fractionated, thereafter a hyperfractionated accelerated scheme was administered more frequently (57%). Accelerated radiotherapy was strongly associated with geographic region (ORsouth vs north: 4.13 (95%CI: 3.00-5.70)), WHO performance (OR1 vs 0: 0.50 (95%CI: 0.35-0.71)), and radiotherapy facilities treating ≥ 16 vs < 16 SCLC patients annually (OR: 3.01 (95%CI: 2.38-3.79)). CONCLUSIONS: The use of surgery increased in stage I. In stages II and III, the use of cCRT versus sCRT increased over time, and since 2012 most radiotherapy in cCRT was accelerated. Treatment regimens and radiotherapy fractionation schemes varied between patient groups, regions and hospitals. Possible unwarranted treatment variation should be countered.
OBJECTIVES: Recent treatment patterns for small cell lung cancer (SCLC) in the Netherlands were unknown. This nationwide population-based study describes trends and variations in the treatment of stage I-III SCLC in the Netherlands over the period 2008-2019. MATERIALS AND METHODS: Patients were selected from the population-based Netherlands Cancer Registry. Treatments were studied stratified for clinical stage. In stage II-III, factors associated with the use of concurrent (cCRT) versus sequential chemoradiation (sCRT) and accelerated versus conventionally fractionated radiotherapy in the context of cCRT were identified. RESULTS: In stage I (N = 535), 29% of the patients underwent surgery in 2008-2009 which increased to 44% in 2018-2019. Combined use of chemotherapy and radiotherapy decreased in stage I from 47% to 15%, remained constant (64%) in stage II (N = 472), and increased from 57% (2008) to 70% (2019) in stage III (N = 5,571). Use of cCRT versus sCRT in stage II-III increased over time (odds ratio (OR) 2008-2011 vs 2016-2019: 0.53 (95%-confidence interval (95%CI): 0.41-0.69)) and was strongly associated with lower age, WHO performance status 0, and diagnosis in a hospital with in-house radiotherapy. Forty-six percent of patients with stage III received cCRT in 2019. Until 2012, concurrent radiotherapy was mainly conventionally fractionated, thereafter a hyperfractionated accelerated scheme was administered more frequently (57%). Accelerated radiotherapy was strongly associated with geographic region (ORsouth vs north: 4.13 (95%CI: 3.00-5.70)), WHO performance (OR1 vs 0: 0.50 (95%CI: 0.35-0.71)), and radiotherapy facilities treating ≥ 16 vs < 16 SCLC patients annually (OR: 3.01 (95%CI: 2.38-3.79)). CONCLUSIONS: The use of surgery increased in stage I. In stages II and III, the use of cCRT versus sCRT increased over time, and since 2012 most radiotherapy in cCRT was accelerated. Treatment regimens and radiotherapy fractionation schemes varied between patient groups, regions and hospitals. Possible unwarranted treatment variation should be countered.
Authors: Giulia Pasello; Martina Lorenzi; Giulia Pretelli; Giovanni Maria Comacchio; Federica Pezzuto; Marco Schiavon; Alessandra Buja; Stefano Frega; Laura Bonanno; Valentina Guarneri; Fiorella Calabrese; Federico Rea Journal: Front Oncol Date: 2022-06-29 Impact factor: 5.738