ESTRO 2024 - Abstract Book

S2807

Interdisciplinary - Health economics & health services research

ESTRO 2024

In this retrospective population-based study, we analysed patients who developed their first and only tumour in the 5 years 2009-2013 and had 5 years of vital-status updates. All tumour sites (excluding C44, non-melanoma skin cancer) and all ages were included. More than 1 million patients were analysed [n=1,029,569], of whom > ½ million [n=537,970] survived 5 years. We used 5-year survival as a surrogate for cure and an indirect assessment of treatment intent. By analysing 5-year survival from diagnosis, we have individual survival outcome data for >½ million ‘real world’ cancer patients at a well -defined time-point, treated with the most contemporaneous treatments of the time. Although the data relate to treatments delivered 10 years ago, they are powerful because they are associated with individual patient outcomes. Treatment data for the 5-year survivors was analysed to identify patients who received at least one course of (X-ray) radiotherapy, chemotherapy and/or surgery. Cases were divided into 22 tumour sites plus a category of ‘Other’. This ‘Other’ category was excluded because it would have no meaning for a tumour site -specific analysis, leaving a total of 508,753 five-year survivors with known tumour site diagnosis.

Results:

Overall 5-year survival was 52%. Of these, 90% had at least one record of surgery, RT or chemotherapy; RT was delivered to 39%.

Of the 508,753 five- year survivors with definite tumour site diagnosis (i.e. excluding ‘Other’), 200,269 (39%) received RT. Breast cancer RT accounted for 50% of patients, prostate men 24%, head and neck cancer patients 6%, and rectum cases 5%, totalling 85%. The remaining 15% of patients receiving RT were distributed amongst the other 18 tumour types. Non-Hodgkin lymphoma (NHL) patients represented 3% of the total, Hodgkin Disease (HD) patients 1%. Of the patients who received RT, 59% survived 5 years or more. Considering patients by specific tumour type, 75% of breast cancer patients received RT, 65% of head and neck patients, 49% of rectum patients, 49% of CNS cases, and 43% of prostate men. Interestingly, 31% of HD patients, 24% of NHL patients and 27% of myeloma patients received RT. By comparison, only 29% of lung cancer patients who survived 5 years had received RT (Figure 1). The lowest use of RT was 2% in patients with melanoma.

Use of surgery exceeded 90% of patients in 9 (of 22) tumour sites. The lowest use was 37% in patients with leukaemia.

In 6 tumour sites (pancreas, leukaemia, kidney, colon, ovary, and melanoma), <5% of patients received RT, a total of 3981 patients. Excluding these, exactly 50% of 5-year survivors received RT. In 8 tumour sites (these 6 plus stomach and testis) 6% or fewer patients received RT, a total of 4621. These 4621 represent just 4% of the 127,961 non-RT patients. The next lowest use was 15% in patients with bladder cancer. RT is used significantly in two thirds of tumour types (14/22) and on average 51% of 5-year survivors with these tumours received RT.