Utilisation of radiotherapy in lung cancer: A scoping narrative literature review with a focus on the introduction of evidence-based therapeutic approaches in Europe

Julieta Corral; Josep M Borras; Yolande Lievens

doi:10.1016/j.ctro.2023.100717

Utilisation of radiotherapy in lung cancer: A scoping narrative literature review with a focus on the introduction of evidence-based therapeutic approaches in Europe

Clin Transl Radiat Oncol. 2023 Dec 18:45:100717. doi: 10.1016/j.ctro.2023.100717. eCollection 2024 Mar.

Authors

Julieta Corral^{1

2}, Josep M Borras^{2

3}, Yolande Lievens^{4

5}

Affiliations

¹ Catalonian Cancer Plan, Department of Health, Barcelona, Spain.
² Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain.
³ Department of Clinical Sciences, University of Barcelona, Spain.
⁴ Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
⁵ Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

Abstract

Background and purpose: The aim of this study was to review the published studies on the utilisation of radiotherapy in lung cancer (both small and non-small cell lung cancer, SCLC and NSCLC) patients in European countries with a population-based perspective.

Material and methods: A literature search since January 2000 until December 2022 was carried out. Only English-published papers were included, and only European data was considered. PRISMA guidelines were followed. A scoping narrative review was undertaken due to the hetereogeneity of the published papers.

Results: 38 papers were included in the analysis, with the majority from the Netherlands (52.6%) and the UK (18.4%). Large variability is observed in the reported radiotherapy utilisation, around 40% for NSCLC in general and between 26 and 42% in stage I NSCLC. Stereotactic body radiotherapy (SBRT) shows a wide range of utilisation across countries and over time, from 8 to 63%. Similary, in stage III lung cancer, chemoradiotherapy (CRT) utilisation varied considerably (11-70%). Eleven studies compared radiotherapy utilisation between older and younger age-groups, showing that younger patients receive more CRT, while the opposite applies for SBRT. An widespreadlack of data on relevant covariates such as comorbidty and health-services related variables is observed.

Conclusion: The actual utilisation of radiotherapy for lung cancer reported in patterns-of-care studies (POCs) is notably lower than the evidence-based optimal utilisation. Important variability is observed by country, time period, stage at diagnosis and age. A wider use of POCs should be promoted to improve our knowledge on the actual application of evidence-based treatment recommendations.

Keywords: Lung Cancer; Patterns of care; Radiation Oncology; Utilisation.