Population-based Results of Chemoradiotherapy for Limited Stage Small Cell Lung Cancer in The Netherlands

Treatment guidelines for limited stage small cell lung cancer (LS-SCLC) favour early concurrent chemoradiotherapy (CRT). Little is known about contemporary, real-world treatment patterns and outcome. We evaluated population-based practice patterns of CRT and corresponding survival in the Netherlands, focusing on the impact of the 2011 national guidelines recommending use of twice-daily (BID) radiotherapy, and treatment outcomes in elderly patients.

Data for 1635 patients with LS-SCLC treated with CRT from 2010 to 2014 were retrieved from the Netherlands Cancer Registry. The type of CRT was designated as either concurrent BID, concurrent once-daily (OD), concurrent atypical or sequential. Overall survival was the primary end point and prognostic factors were evaluated with multivariable Cox regression and represented by hazard ratios and 95% confidence intervals.

The most common form of CRT used was sequential (41%). The proportion of patients treated BID increased from 13% in 2010-2011 to 36% in 2013-2014 (P < 0.001). The median survival was 21 months and did not improve with time (P = 0.58). Five year survival was 16% for sequential, 31% for BID (hazard ratio = 0.67, confidence interval 0.57-0.79) and 28% for OD (hazard ratio = 0.73, confidence interval 0.63-0.85). In patients aged 70 years and older, concurrent CRT was less often used than in younger patients (45% versus 66%) and 5 year survival after concurrent CRT was less favourable; 18% versus 32%, respectively.

Outcome data at the population level for LS-SCLC are equivalent to those reported in clinical trials. The increased use of BID schemes since 2011 did not improve survival.