title: A population-based study on the utilisation rate of primary radiotherapy for prostate cancer in 4 regions in the Netherlands, 1997-2008.
abstract: OBJECTIVE
  The purpose was to study variations in utilisation rates of external beam radiotherapy (EBRT) and brachytherapy (BT) for prostate cancer patients.
  
  
  METHODS
  We calculated the proportion and number of EBRT and BT given or planned within 6 months of diagnosis in 4 Dutch regions, according to stage and age in a population-based setting including 47,259 prostate cancer patients diagnosed from 1997 until 2008.
  
  
  RESULTS
  During this study period, the overall utilisation rate of EBRT remained stable at around 25%, while the rate of BT for non-metastasized patients increased from 1% (95% CI:0-1%) to 12% (11-13%) in 2006 and slightly decreased towards 10% (9-11%) in 2008. From 2001 on, the overall utilisation rate of EBRT decreased significantly in one region (p<0.05). In this region, a sharp rise in the utilisation rate of BT for non-metastatic patients was noted to 17% (14-20%) in 2008 after a peak of 24% (21-27%) in 2006. For localised disease, BT was used more often at the expense of EBRT while for locally advanced disease the utilisation rate of EBRT increased. In the multivariate analysis, regional differences in the utilisation rate of EBRT persisted with odds ratios ranging from 0.7 to 0.9 compared to the reference region. Moreover, low rates of EBRT were associated with high BT rates. The regional differences could not be explained by differences in risk profiles.
  
  
  CONCLUSIONS
  The utilisation rate of EBRT remained stable with limited variation between regions while BT was used increasingly with clear regional differences. To cope with this and in view of the increasing incidence of prostate cancer, adequate resources have to be planned for the optimal care of these patients.
authors.affiliation: Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands.
authors.forename: P M P
authors.initials: PM
authors.lastname: Poortmans
authors.forename: M J
authors.initials: MJ
authors.lastname: Aarts
authors.forename: J J
authors.initials: JJ
authors.lastname: Jobsen
authors.forename: C C E
authors.initials: CC
authors.lastname: Koning
authors.forename: M L M
authors.initials: ML
authors.lastname: Lybeert
authors.forename: H
authors.initials: H
authors.lastname: Struikmans
authors.forename: J C M
authors.initials: JC
authors.lastname: Vulto
authors.forename: W J
authors.initials: WJ
authors.lastname: Louwman
authors.forename: J W W
authors.initials: JW
authors.lastname: Coebergh
authors.forename: E L
authors.initials: EL
authors.lastname: Koldewijn
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D012042:Registries