title: Underuse of radiotherapy in lung cancer has negative consequences for patients.
abstract: BACKGROUND
  Radiotherapy has proven to be an effective treatment when used alone or with other therapies. However, underuse of radiotherapy has been observed in various studies. The objective of this investigation was to assess the use of radiotherapy as initial treatment for lung cancer in a southern region of Europe.
  
  
  METHODS
  A systematic review of lung cancer treatment guidelines and observational studies was performed to estimate expected radiation rates and the associated survival outcomes. We then reviewed the clinical and treatment records of all patients undergoing radiotherapy for lung cancer during 2007 in all the 12 public hospitals in Andalusia with radiotherapy facilities. Data were grouped according to type of hospital, patient, treatment characteristics, histological type, and tumor stage.
  
  
  RESULTS
  In 2007, of the 3051 patients estimated to be diagnosed with lung cancer, 610 were treated with initial radiotherapy with an overall radiation rate of 20%, which significantly differed among provinces (range, 8.5%-25.6%, p < 0.001). Given the expected radiation rate of 1383 patients, 773 more patients of lung cancer (25%) should have been treated. According to the literature, the maximum increased survival attributable to the use of radiotherapy in patients diagnosed with non-small-cell lung cancer ranges from 1.8 to 14.1 months. The underuse estimated in the region would correspond to a loss of more than 3000 months in survival time.
  
  
  CONCLUSIONS
  The observed underuse of radiotherapy in lung cancer in our region should be a matter of concern, given its negative and measurable impact on the survival of the patients.
authors.affiliation: Radiation Oncology Department, Virgen de las Nieves University Hospital, Granada, Spain. aris.tovar@gmail.com
authors.forename: Isabel
authors.initials: I
authors.lastname: Tovar
authors.forename: José
authors.initials: J
authors.lastname: Expósito
authors.forename: Javier
authors.initials: J
authors.lastname: Jaén
authors.forename: Enrique
authors.initials: E
authors.lastname: Alonso
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D019983:Guideline Adherence; D006779:Hospitals, Public / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008485:Medical Audit; D020360:Neoadjuvant Therapy / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D013030:Spain; D016019:Survival Analysis