Radiotherapy use during 1st phase of cancer treatment declining across US

Fewer Americans are receiving radiotherapy during their first course of cancer treatment than a decade ago, a trio of researchers reported in the Journal of the American College of Radiology this month—and more are turning to systemic therapy as an alternative.

Radiotherapy has undergone a handful of advanced technical changes over the years, first author Trevor J. Royce, MD, MS, MPH, and co-authors wrote in JACR, prompted in part by more sophisticated knowledge of radiation itself. But no timeline exists to measure that progress.

“The changing use of radiation as a first-line cancer therapy in the United States is poorly characterized,” Royce and colleagues said. “Understanding how radiation utilization rates have changed with advances is unclear, although reportedly nearly half of all cancer patients will receive radiotherapy at some point during their cancer care.”

The researchers launched a retrospective study of solid tumor cases reported in the National Cancer Data Base between 2004 and 2014 “to better understand the evolution of contemporary radiotherapy and fractionation use,” the latter of which has been the subject of recent guideline changes. Several organizations, including the American Society for Radiation Oncology, have been supporting the use of shorter fractionation regimens in breast and prostate cancer therapies.

Royce et al.’s work involved sub-categorizing patients by tumor sites and studying how rates of radiotherapy, systemic therapy and surgical therapy utilization, as well as number of treatment and fractionations, changed over time.

Radiotherapy itself declined in use a modest 2.7 percent, sinking steadily from 33.9 percent in 2004 to 31.2 percent in 2014, the authors said. Systemic therapy, on the other hand, jumped from 37.3 percent to 44.1 percent, and surgical therapy utilization remained steady, around 68 percent. Patients with genitourinary, head and neck and central nervous system diseases saw the greatest drops, with radiotherapy use in genitourinary cases shrinking 42.5 percent over the study period.

“These findings are significant for several reasons and highlight the changing role of radiation oncology during the first line of cancer care,” Royce and co-authors wrote. “They may suggest a nationwide decrease in the use of radiotherapy during the first course of treatment, driven by a decrease in genitourinary cancers and decreased radiotherapy utilization across multiple cancer sites.”

Radiotherapy also increased in gastrointestinal, musculoskeletal, skin and thoracic malignancies, the researchers reported, though mean fractionation declined from 28.7 to 25.2.

“This decline in the mean number of fractions per patient persisted in nonpalliative, nonstereotactic treatments,” Royce and colleagues said.