The management of stage I Non-Small cell lung cancer (NSCLC) in Ontario: A Population-Based study of patterns of care and Stereotactic Ablative Body radiotherapy (SABR) utilization from 2010 to 2019

• Published in: Radiotherapy and oncology Vol. 194; p. 110153
• Main Authors: Ashworth, Allison, Kong, Weidong, Owen, Timothy, Hanna, Timothy P., Brundage, Michael
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2024
• Subjects: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Non-Small-Cell Lung - surgery; Female; Hematology, Oncology, and Palliative Medicine; Humans; Lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Lung Neoplasms - surgery; Male; Middle Aged; Neoplasm Staging; Ontario; Population-based; Practice Patterns, Physicians' - statistics & numerical data; Radiation therapy; Radiosurgery - methods; Retrospective Studies; stage I NSCLC; Stereotactic Ablative Body Radiotherapy (SABR); Stereotactic Body Radiotherapy (SBRT); Ontario; Stereotactic Body Radiotherapy (SBRT); Population-based; Radiation therapy; stage I NSCLC; Stereotactic Ablative Body Radiotherapy (SABR); Lung cancer; lung cancer; population-based; radiation therapy
• ISSN: 0167-8140; 1879-0887; 1879-0887
• DOI: 10.1016/j.radonc.2024.110153

•This population-based study describes the management of stage I NSCLC, 2010–2019.•The utilization of SABR increased, while surgery and observation decreased.•Substantial practice variation was observed amongst the 14 Ontario health regions.•From 2010 to 2019, 2 yr-OS and CSS over time improved for all stage I and surgically managed patients. Stereotactic Ablative Body Radiotherapy (SABR) is the standard of care for medically inoperable patients with Stage I NSCLC. The adoption of SABR and its association with cancer outcomes requires characterization. We described the management of biopsy-proven Stage I NSCLC with SABR, surgery, non-SABR curative radiotherapy (RT) and observation in Ontario, Canada, between 2010 and 2019. Temporal and geographic trends in practice and survival outcomes were analyzed. This was a retrospective population-based cohort study conducted by linking electronic radiotherapy (RT) records to a population-based cancer registry. A total of 12,065 patients were identified, 61.7 % underwent surgery, 17.9 % received SABR, 8.6 % received non-SABR curative RT and 11.7 % were observed. Between 2010 and 2019, the utilization of surgery decreased (63.8 % to 49.9 %, p < 0.0001), while SABR use increased (7.5 % to 24.4 %, p < 0.0001), non-SABR curative RT use increased (6.7 % to 9.6 %, p < 0.0014) and patients observed decreased (14.4 % to 12.0 %, p < 0.0001). Substantial variation in practice exists across Ontario. Two- yr CSS improved for the entire cohort (81.9 % to 85.0 %, p < 0.0001). While there was improvement in 2 yr CSS for surgical patients (92.1 %% to 95.7 %, p < 0.001), survival for patients who received SABR, Non-SABR curative RT and observation remained stable. There has been an increase in SABR utilization and a reduction in surgical utilization with a corresponding increased survival of stage I patients in Ontario between 2010 and 2019. Substantial differences in practice patterns exist across health regions, suggesting the need for strategies to improve access to SABR in many jurisdictions.