Trends and Variation in the Use of Radiotherapy in Non-metastatic Rectal Cancer: a 14-year Nationwide Overview from the Netherlands

This study describes nationwide primary radiotherapy utilisation trends for non-metastasised rectal cancer in the Netherlands between 2008 and 2021. In 2014, both colorectal cancer screening and a new guideline specifying prognostic risk groups for neoadjuvant treatment were implemented. Patients wi...

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Bibliographic Details
Published in:Clinical oncology (Royal College of Radiologists (Great Britain)) 2024-04, Vol.36 (4), p.221-232
Main Authors: Verrijssen, A.E., Evers, J., van der Sangen, M., Siesling, S., Aarts, M.J., Struikmans, H., Bloemers, M.C.W.M., Burger, J.W.A., Lemmens, V., Braam, P.M., Elferink, M.A.G., Berbee, M.
Format: Article
Language:English
Subjects:
Dutch overview
national cancer registry
radiotherapy
rectal cancer
treatment trends
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Summary:This study describes nationwide primary radiotherapy utilisation trends for non-metastasised rectal cancer in the Netherlands between 2008 and 2021. In 2014, both colorectal cancer screening and a new guideline specifying prognostic risk groups for neoadjuvant treatment were implemented. Patients with non-metastasised rectal cancer in 2008–2021 (n = 37 510) were selected from the Netherlands Cancer Registry and classified into prognostic risk groups. Treatment was studied over time and age. Multilevel logistic regression analyses were carried out to identify factors associated with (i) radiotherapy versus chemoradiotherapy use for intermediate rectal cancer and (ii) chemoradiotherapy without versus with surgery for locally advanced rectal cancer. For early rectal cancer, the use of neoadjuvant radiotherapy decreased (15% to 5% between 2008 and 2021), whereas the use of endoscopic resections increased (8% in 2015, 17% in 2021). In intermediate-risk rectal cancer, neoadjuvant chemoradiotherapy (43% until 2011, 25% in 2015) shifted to radiotherapy (42% in 2008, 50% in 2015), the latter being most often applied in older patients. In locally advanced rectal cancer, the use of chemoradiotherapy without surgery increased (2–4% in 2008–2013, 17% in 2019–2021). Both neoadjuvant treatment in intermediate disease and omission of surgery following chemoradiotherapy in locally advanced disease varied with increasing age (odds ratio>75vs
ISSN:0936-6555
1433-2981
DOI:10.1016/j.clon.2024.01.013