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Evers J, Kerkmeijer LGW, van den Bergh RCN, van der Sangen MJC, Hulshof MCCM, Bloemers MCWM, Siesling S, Aarts MJ, Aben KKH, Struikmans H. Trends and variation in the use of radiotherapy in non-metastatic prostate cancer: A 12-year nationwide overview from the Netherlands. Radiother Oncol 2022; 177:134-142. [PMID: 36328090 DOI: 10.1016/j.radonc.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/28/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE This population-based study describes nationwide trends and variation in the use of primary radiotherapy for non-metastatic prostate cancer in The Netherlands in 2008-2019. METHODS Prostate cancer patients were selected from the Netherlands Cancer Registry (N = 103,059). Treatment trends were studied over time by prognostic risk groups. Multilevel analyses were applied to identify variables associated with external beam radiotherapy (EBRT) and brachy-monotherapy versus no active treatment in low-risk disease, and EBRT versus radical prostatectomy in intermediate and high-risk disease. RESULTS EBRT use remained stable (5-6%) in low-risk prostate cancer and increased from 21% to 32% in intermediate-risk, 37% to 45% in high-risk localized and 50% to 57% in high-risk locally advanced disease. Brachy-monotherapy decreased from 19% to 6% and from 15% to 10% in low and intermediate-risk disease, respectively, coinciding an increase of no active treatment from 55% to 73% in low-risk disease. Use of EBRT or brachy-monotherapy versus no active treatment in low-risk disease differed by region, T-stage and patient characteristics. Hospital characteristics were not associated with treatment in low-risk disease, except for availability of brachy-monotherapy in 2008-2013. Age, number of comorbidities, travel time for EBRT, prognostic risk group, and hospital characteristics were associated with EBRT versus prostatectomy in intermediate and high-risk disease. CONCLUSION Intermediate/high-risk PCa was increasingly managed with EBRT, while brachy-monotherapy in low/intermediate-risk PCa decreased. In low-risk PCa, the no active treatment-approach increased. Variation in treatment suggests treatment decision related to patient/disease characteristics. In intermediate/high-risk disease, variation seems furthermore related to the treatment modalities available in the diagnosing hospitals.
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Affiliation(s)
- Jelle Evers
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Center, Hallenweg 5, 7522 NH Enschede, the Netherlands.
| | - Linda G W Kerkmeijer
- Radboud University Medical Center, Department of Radiation Oncology, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | | | - Maurice J C van der Sangen
- Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Maarten C C M Hulshof
- Amsterdam University Medical Center, Department of Radiation Oncology, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Monique C W M Bloemers
- The Netherlands Cancer Institute, Department of Radiation Oncology, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Center, Hallenweg 5, 7522 NH Enschede, the Netherlands
| | - Mieke J Aarts
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
| | - Katja K H Aben
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, the Netherlands
| | - Henk Struikmans
- Leiden University Medical Center, Department of Radiation Oncology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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