title: Early-stage lung cancer in elderly patients: a population-based study of changes in treatment patterns and survival in the Netherlands.
abstract: BACKGROUND
  Elderly patients with stage I non-small-cell lung cancer are less likely to undergo curative treatment. However, the introduction of new treatment options such as stereotactic ablative radiotherapy (SABR) may improve treatment rates. We evaluated time trends in treatment patterns and survival in the entire Netherlands population for patients diagnosed between 2001 and 2009.
  
  
  METHODS
  Details of 4605 elderly Dutch patients were obtained from the Netherlands Cancer Registry, containing data on all cancer patients in a population of 16 million. Three consecutive time periods were studied: 2001-2003 (A, before SABR became available), 2004-2006 (B, increasing availability), and 2007-2009 (C, full availability).
  
  
  RESULTS
  Between period A and C, there was a 7% absolute reduction in patients going untreated, corresponding to an 8-month improvement in median survival (P < 0.001). Radiotherapy utilization increased from 31% to 38%, whereas surgical utilization remained constant (37%). Significant improvements in survival were observed in the radiotherapy subgroup (P < 0.001) and surgery subgroup (P < 0.001), not in patients going untreated. There was no evidence of stage migration.
  
  
  CONCLUSIONS
  Population-based increases in survival of elderly stage I lung cancer patients were seen between 2001 and 2009. The introduction of SABR correlated with a decline in the number of untreated patients.
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: cja.haasbeek@vumc.nl.
authors.forename: C J A
authors.initials: CJA
authors.lastname: Haasbeek
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, London Regional Cancer Program, London, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Palma
authors.affiliation: Comprehensive Cancer Center The Netherlands, Amsterdam, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Visser
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: Lagerwaard
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Slotman
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Senan
mesh_terms: D000368:Aged; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000628:therapy; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D015996:Survival Rate