TY - JOUR
T1 - Trends and variations in treatment of stage I-III non-small cell lung cancer from 2008 to 2018
T2 - A nationwide population-based study from the Netherlands
AU - Evers, Jelle
AU - de Jaeger, Katrien
AU - Hendriks, Lizza E.L.
AU - van der Sangen, Maurice
AU - Terhaard, Chris
AU - Siesling, Sabine
AU - de Ruysscher, Dirk
AU - Struikmans, Henk
AU - Aarts, Mieke J.
N1 - 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 from their clinical knowledge and review of the manuscript. It remained up to the first author whether or not to incorporate these suggestions.
Funding Information:
Dr. Hendriks reports other support from Boehringer Ingelheim to the institute, other support from BMS to the institute, other support from Roche Genentech, other support from AstraZeneca, other support from Eli Lilly to the institute, other support from Pfizer to the institute, other support from MSD to the institute, other support from Takeda to the institute, other support from Amgen to the institute, grants from Roche Genentech to the institute, grants from Boehringer Ingelheim to the institute, grants from AstraZeneca to the institute, personal fees from Quadia, non-financial support from AstraZeneca, non-financial support from Novartis, non-financial support from BMS, non-financial support from MSD/Merck, non-financial support from GSK, non-financial support from Takeda, non-financial support from Blueprint Medicines, non-financial support from Roche Genentech, non-financial support from Janssen Pharmaceuticals, non-financial support from Mirati: all outside the submitted work.
Funding Information:
Drs. Evers reports a grant from the Dutch Association of Radiation Oncology, for the conduct of this study.
Publisher Copyright:
© 2021 The Authors
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - UT-Hybrid-D
U2 - 10.1016/j.lungcan.2021.03.013
DO - 10.1016/j.lungcan.2021.03.013
M3 - Article
SN - 0169-5002
VL - 155
SP - 103
EP - 113
JO - Lung cancer
JF - Lung cancer
ER -
