Trends and variations in the treatment of stage I-III small cell lung cancer from 2008 to 2019: A nationwide population-based study from the Netherlands

Jelle Evers*, Lizza E.l. Hendriks, Katrien De Jaeger, Robin Wijsman, Dirk De Ruysscher, Chris Terhaard, Maurice Van Der Sangen, Sabine Siesling, Henk Struikmans, Mieke J. Aarts

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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 (OR south vs north: 4.13 (95%CI: 3.00–5.70)), WHO performance (OR 1 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.

Original languageEnglish
Pages (from-to)61-70
Number of pages10
JournalLung cancer
Volume162
Early online date28 Oct 2021
DOIs
Publication statusPublished - 1 Dec 2021

Keywords

  • UT-Hybrid-D

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