title: Availability and outcomes of radiotherapy in Central Poland during the 2005-2012 period - an observational study.
abstract: BACKGROUND
  Using a cross-database integrative approach, we performed an epidemiological analysis in a representative region of central Poland to evaluate the availability of radiotherapy (RTx) and overall survival of adult patients undergoing RTx for cancer.
  
  
  METHODS
  Epidemiological data on cancer incidence in the 2005-2012 period were obtained from the Nationwide Cancer Registry. Using data from the Ministry of Internal Affairs, we collected survival information of all patients treated in the only centre providing RTx for a region inhabited by approximately 2.6 million people.
  
  
  RESULTS
  After filtering out individuals on the basis of exclusion criteria, the final dataset covered 17,736 patients. Availability of RTx increased marginally, from 23.5% (2005) to 24.4% (2011, R = 0.39, p = 0.38), with the highest values noted in patients with cervical (78.5%), prostate (70.6%) and breast cancer (62.7%). However, due to the decreasing population of the region, we noted increasing disparity in the likelihood of receiving RTx depending on the patient's area of residence, with rural areas becoming progressively more neglected. The best prognosis was noted among patients with breast or prostate cancer with 5-year OS rates reaching 81.2% and 83.3%, respectively. Multivariate analysis controlling for type of diagnosis and patient age showed a time-dependent improvement in outcomes (HR(95% CI): 0.96(0.94-0.98); p < 0.0001).
  
  
  CONCLUSIONS
  Availability of RTx in Poland is still below that reported by developed European centres. Survival of patients undergoing radical RTx has gradually improved, although it is still below that of leading RTx departments, potentially due to delayed diagnosis or organisational barriers, necessitating further investigations.
authors.affiliation: Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland. justyna.chalubinska-fendler@e.umed.lodz.pl.
authors.forename: Justyna
authors.initials: J
authors.lastname: Chalubinska-Fendler
authors.affiliation: Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland. wojciech.fendler@umed.lodz.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Fendler
authors.affiliation: Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland. michal.spych@umed.lodz.pl.
authors.forename: Michal
authors.initials: M
authors.lastname: Spych
authors.affiliation: Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland. jolabury@wp.pl.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Luniewska-Bury
authors.affiliation: Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland. wojciech.mlynarski@umed.lodz.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mlynarski
authors.affiliation: Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland. jacekf@coi.waw.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Fijuth
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D049674:History, 21st Century; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000266:history / Q000532:radiotherapy*; D011044:Poland / Q000453:epidemiology; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012042:Registries; D016896:Treatment Outcome