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Verrijssen AE, Evers J, van der Sangen M, Siesling S, Aarts MJ, Struikmans H, Bloemers MCWM, Burger JWA, Lemmens V, Braam PM, Elferink MAG, Berbee M. Trends and Variation in the Use of Radiotherapy in Non-metastatic Rectal Cancer: a 14-year Nationwide Overview from the Netherlands. Clin Oncol (R Coll Radiol) 2024; 36:221-232. [PMID: 38336504 DOI: 10.1016/j.clon.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/23/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
AIMS 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. MATERIALS AND METHODS 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. RESULTS 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<50: 2.17, 95% confidence interval 1.54-3.06) and treatment region (Southwest and Northwest odds ratio 0.63, 95% confidence interval 0.42-0.93 and odds ratio 0.65, 95% confidence interval 0.44-0.95, respectively, compared with the North). CONCLUSION Treatment patterns in non-metastasised rectal cancer significantly changed over time. Effects of both the national screening programme and the new treatment guideline were apparent, as well as a paradigm shift towards organ preservation (watch-and-wait). Observed regional variations may indicate adoption differences regarding new treatment strategies.
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Affiliation(s)
- A E Verrijssen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands.
| | - J Evers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - M van der Sangen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - S Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - M J Aarts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - H Struikmans
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M C W M Bloemers
- Department of Radiation Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - V Lemmens
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - P M Braam
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M A G Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - M Berbee
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands
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Heijligers M, Verheijden LMM, Jonkman LM, van der Sangen M, Meijer-Hoogeveen M, Arens Y, van der Hoeven MA, de Die-Smulders CEM. The cognitive and socio-emotional development of 5-year-old children born after PGD. Hum Reprod 2018; 33:2150-2157. [DOI: 10.1093/humrep/dey302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Heijligers
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - L M M Verheijden
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - L M Jonkman
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - M van der Sangen
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Meijer-Hoogeveen
- Department of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y Arens
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - M A van der Hoeven
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
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Claessens A, Bos M, de Groot S, van Leeuwen-Stok E, Lopez-Yurda M, Honkoop A, de Graaf H, van Druten E, van Warmerdam L, van der Sangen M, Tjan-Heijnen V, Erdkamp F. Efficacy of two times four versus continuous eight cycles of paclitaxel/bevacizumab as first-line chemotherapy in metastatic breast cancer: The Stop&Go study of the Dutch Breast Cancer Research Group (BOOG). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bernards N, Haj Mohammad N, Creemers GJ, Rozema T, Roukema JA, Nieuwenhuijzen GAP, van Laarhoven HWM, van der Sangen M, Lemmens VEPP. Improvement in survival for patients with synchronous metastatic esophageal cancer in the south of the Netherlands from 1994 to 2013. Acta Oncol 2016; 55:1161-1167. [PMID: 27174793 DOI: 10.1080/0284186x.2016.1176249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We assessed the use of external beam radiotherapy, brachytherapy chemoradiotherapy and chemotherapy in patients with metastatic esophageal cancer and evaluated the effect on overall survival. METHODS We included all patients diagnosed with synchronous metastatic esophageal cancer in the south of the Netherlands between 1 January 1994 and 31 December 2013. Proportions of patients treated with external beam radiotherapy, brachytherapy, chemoradiotherapy and chemotherapy were described with respect to the period of diagnosis, patient and tumor characteristics. Independent risk factors for death were discriminated. RESULTS A total of 1020 patients were included, 61.5% of these patients received palliative treatment with external beam radiotherapy, chemoradiotherapy, brachytherapy and/or chemotherapy. The use of external beam radiotherapy decreased from 44.5% in 1994 to 22.2% in 2013 (p = 0.0001), whereas the use of chemoradiotherapy increased from 2.9% in 1994 to 19.1% in 2013 (p < 0.0001). The prescription of systemic chemotherapy as single modality increased from 13.9% to 30.5% (p < 0.0001). The use of brachytherapy decreased from 20.9% in 1994 to 7.4% in 2013 (p = 0.0013). The odds of receiving external beam radiotherapy, brachytherapy, chemoradiotherapy and chemotherapy were influenced by different tumor and patient characteristics, such as age, gender, histologic subtype and number of metastatic sites. The median overall survival in patients with metastatic esophageal cancer significantly improved over time from 18 weeks (one-year survival rate 14.4%) in 1994-1998 to 25 weeks (one-year survival rate 22.4%) in 2009-2013. Patients treated with chemoradiotherapy had the most favorable prognosis, followed by patients treated with chemotherapy as a single modality. CONCLUSION The median overall survival of patients diagnosed with metastatic esophageal cancer improved from 18 weeks in 1994-1998 to 25 weeks in 2009-2013. Although this increase could be attributed to stage migration, our population-based study suggests that major changes in treatment strategies and appropriate patient selection might have played a role as well.
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Affiliation(s)
- N. Bernards
- Department of Research, Comprehensive Cancer Centre Netherlands/Netherlands Cancer Registry, Eindhoven, The Netherlands
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - N. Haj Mohammad
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - G. J. Creemers
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - T. Rozema
- Department of Radiotherapy, Verbeeten Institute, Tilburg, The Netherlands
| | - J. A. Roukema
- Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | | | | | - M. van der Sangen
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| | - V. E. P. P. Lemmens
- Department of Research, Comprehensive Cancer Centre Netherlands/Netherlands Cancer Registry, Eindhoven, The Netherlands
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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van Haaren P, Bierings M, van Boxtel M, van der Leer J, van der Sangen M, Hurkmans C. EP-1270: Accuracy and reliability of CBCT based position verification and correction for IGRT of pancreatic cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Lieshout M, Hagelaar E, van der Sangen M, van Haaren P. OC-0348: Feasibility of IMRT with an integrated boost for oesophageal cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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van der Leij F, Elkhuizen P, Janssen T, Poortmans P, van der Sangen M, Scholten A, van Vliet-Vroegindeweij C, Boersma L. PO-0625 EXTERNAL BEAM PARTIAL BREAST IRRADIATION: DIFFERENCE IN PRE-AND POSTOPERATIVE TARGET VOLUME DELINEATION. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70958-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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