TY - JOUR
T1 - Trends and variations in the treatment of stage I-III small cell lung cancer from 2008 to 2019
T2 - A nationwide population-based study from the Netherlands
AU - Evers, Jelle
AU - Hendriks, Lizza E.L.
AU - De Jaeger, Katrien
AU - Wijsman, Robin
AU - De Ruysscher, Dirk
AU - Terhaard, Chris
AU - van der Sangen, Maurice
AU - Siesling, Sabine
AU - Struikmans, Henk
AU - Aarts, Mieke J.
N1 - Funding Information:
The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry. This work was funded by the Dutch Association of Radiation Oncology (NVRO) which had the opportunity, thanks to external funding, to financially support our study.
Funding Information:
This work was funded by the Dutch Association of Radiation Oncology (NVRO) which had the opportunity, thanks to external funding, to financially support our study. Among the authors are representatives from the NVRO. They had no role in data collection and analysis, but were involved in the interpretation of data based on their clinical knowledge and review of the manuscript. It remained up to the first author whether to incorporate these suggestions.
Publisher Copyright:
© 2021 The Authors
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Epidemiology
KW - Guideline adherence
KW - Patterns of care
KW - Radiotherapy
KW - Small cell lung cancer
KW - Treatment variation
UR - http://www.scopus.com/inward/record.url?scp=85118491029&partnerID=8YFLogxK
U2 - 10.1016/j.lungcan.2021.10.011
DO - 10.1016/j.lungcan.2021.10.011
M3 - Article
AN - SCOPUS:85118491029
SN - 0169-5002
VL - 162
SP - 61
EP - 70
JO - Lung Cancer
JF - Lung Cancer
ER -