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

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2021-12, Vol.162, p.61-70
• Main Authors: Evers, Jelle, Hendriks, Lizza E.L., De Jaeger, Katrien, Wijsman, Robin, De Ruysscher, Dirk, Terhaard, Chris, van der Sangen, Maurice, Siesling, Sabine, Struikmans, Henk, Aarts, Mieke J.
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Non-Small-Cell Lung - drug therapy; Chemoradiotherapy; Epidemiology; Guideline adherence; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - therapy; Neoplasm Staging; Netherlands - epidemiology; Patterns of care; Radiotherapy; Small cell lung cancer; Small Cell Lung Carcinoma - epidemiology; Small Cell Lung Carcinoma - therapy; Treatment variation
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2021.10.011

•Use of surgery increased while use of both chemo- & radiotherapy decreased in stage I.•The rate of both chemo- & radiotherapy increased in stage III up to 70% in 2019.•Use of concurrent versus sequential chemoradiation increased over time (stage II-III)•2013–2019: concurrent radiotherapy was most often accelerated fractionated.•(Possibly unwarranted) variation in treatment between patients, hospitals and regions. 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. 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. 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