Trends and variations in treatment of stage I-III non-small cell lung cancer from 2008 to 2018: A nationwide population-based study from the Netherlands

Jelle Evers*, Katrien de Jaeger, Lizza E.L. Hendriks, Maurice van der Sangen, Chris Terhaard, Sabine Siesling, Dirk de Ruysscher, Henk Struikmans, Mieke J. Aarts

*Corresponding author for this work

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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.

Original languageEnglish
Pages (from-to)103-113
Number of pages11
JournalLung cancer
Early online date20 Mar 2021
Publication statusPublished - May 2021


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