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, Hallenweg 5, 7522 NH Enschede, The Netherlands.
Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Pulmonary Diseases, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Lung Cancer. 2021 Dec;162:61-70. doi: 10.1016/j.lungcan.2021.10.011. Epub 2021 Oct 28.
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) : 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 (OR: 4.13 (95%CI: 3.00-5.70)), WHO performance (OR: 0.50 (95%CI: 0.35-0.71)), and radiotherapy facilities treating ≥ 16 vs < 16 SCLC patients annually (OR: 3.01 (95%CI: 2.38-3.79)).
The use of surgery increased in stage I. In stages II and III, the use of cCRT versus sCRT increased over time, and since 2012 most radiotherapy in cCRT was accelerated. Treatment regimens and radiotherapy fractionation schemes varied between patient groups, regions and hospitals. Possible unwarranted treatment variation should be countered.
最近荷兰小细胞肺癌（SCLC）的治疗模式尚不清楚。本项全国性基于人群的研究描述了 2008-2019 年期间荷兰 I-III 期 SCLC 的治疗趋势和变化。
从基于人群的荷兰癌症登记处中选择患者。按临床分期分层研究治疗方法。在 II-III 期，确定了同期放化疗（cCRT）与序贯放化疗（sCRT）以及 cCRT 中加速与常规分割放疗相关的因素。
在 I 期（N=535），2008-2009 年有 29%的患者接受了手术，而在 2018-2019 年则增加到了 44%。I 期联合化疗和放疗的使用率从 47%降至 15%，在 II 期（N=472）保持不变（64%），在 III 期（N=5571）则从 57%（2008 年）增加到 70%（2019 年）。II-III 期的 cCRT 与 sCRT 的使用率随时间推移而增加（比值比（OR）：0.53（95%置信区间（95%CI）：0.41-0.69）），与较低的年龄、WHO 表现状态 0 和在设有内部放疗的医院诊断强烈相关。2019 年，3 期有 46%的患者接受了 cCRT。2012 年之前，同期放疗主要采用常规分割，此后更频繁地采用超分割加速方案（57%）。加速放疗与地理区域（OR：4.13（95%CI：3.00-5.70））、WHO 表现（OR：0.50（95%CI：0.35-0.71））和每年治疗≥16 例与<16 例 SCLC 患者的放疗设施（OR：3.01（95%CI：2.38-3.79））密切相关。
I 期手术使用率增加。在 II 期和 III 期，cCRT 与 sCRT 的使用率随时间推移而增加，自 2012 年以来，cCRT 中的大多数放疗都是加速放疗。不同患者群体、地区和医院的治疗方案和放疗分割方案存在差异。应避免不必要的治疗差异。
