Abstract
Purpose/ObjectivesThe clinical effects of radiation dose-intensification in locally advanced non-small cell lung (NSCLCa) and other cancers are challenging to predict and are ideally studied in randomized trials. The purpose of this study was to assess the use of dose-escalated radiation for locally advanced NSCLCa in the U.S., 2004–2013, a period in which there were no published level 1 studies on dose-escalation.Materials/MethodsWe performed analyses on two cancer registry databases with complementary strengths and weaknesses: the National Oncology Data Alliance (NODA) 2004–2013 and the National Cancer Database (NCDB) 2004–2012. We classified locally advanced patients according to the use of dose-escalation (>70 Gy). We used adjusted logistic regression to assess the association of year of treatment with dose-escalated radiation use in two periods representing time before and after the closure of a cooperative group trial (RTOG 0617) on dose-escalation: 2004–2010 and 2010–2013. To determine the year in which a significant change in dose could have been detected had dose been prospectively monitored within the NODA network, we compared the average annual radiation dose per year with the forecasted dose (average of the prior 3 years) adjusted for patient age and comorbidities.ResultsWithin both the NODA and NCDB, use of dose-escalation increased from 2004 to 2010 (p < 0.0001) and decreased from 2010 to 2013 (p = 0.0018), even after controlling for potential confounders. Had the NODA network been monitoring radiation dose in this cohort, significant changes in average annual dose would have been detected at the end of 2008 and 2012.ConclusionsPatterns of radiation dosing in locally advanced NSCLCa changed in the U.S. in the absence of level 1 evidence. Monitoring radiation dose is feasible using an existing national cancer registry data collection infrastructure.
Highlights
Incremental technical advances in linear accelerators have steadily improved the delivery of radiotherapy to a patient’s tumor while sparing the adjacent normal tissue
Patterns of radiation dosing in locally advanced non-small cell lung cancer (NSCLCa) changed in the U.S in the absence of level 1 evidence
Data sources The primary analyses of this study were performed on data extracted from two cancer registry databases with complementary strengths and weaknesses: the National Oncology Data Alliance® (NODA) (Elekta Inc., Sunnyvale, CA), years 2004–2013, and the National Cancer Database (NCDB) (American College of Surgeons, Chicago, Il), years 2004–2012
Summary
Incremental technical advances in linear accelerators have steadily improved the delivery of radiotherapy to a patient’s tumor while sparing the adjacent normal tissue. Leveraging advances in technology to dose-intensify is compelling in diseases for which local control outcomes are poor, such as inoperable locally advanced non-small cell lung cancer (NSCLCa) which has an estimated 2-year local failure rate of 30% when. To assess the first of these hypotheses, that radiation dose creep occurs, we evaluated the patterns of radiation dosing in locally advanced NSCLCa between 2004 and 2013, a period in which there were no published level 1 studies on doseescalation. We sought to determine the year in which a significant change in radiation dosing practice patterns could have been detected in this study period had dose been prospectively monitored using commonly available cancer registry data We hypothesized that there would be an increasing trend in the use of dose-escalated radiation in the years preceding the closure of RTOG 0617 and that there would be a decreasing trend beginning immediately preceding the study’s closure to the end of the study period.
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