Referral rates and trends in radiotherapy as part of primary treatment of cancer in South Netherlands, 1988-2002

Background and purpose: To study referral rates and time trends in the use of primary radiotherapy (RT). Patients and Methods: The proportion and number of irradiated patients were calculated in a population-based setting among 58,436 cancer patients diagnosed between 1988 and 2002. Results: The number of patients receiving RT within 6 months of diagnosis (RT6mo) increased by about 3.3% annually, the proportion of all incident cases that received RT6mo remained stable (±30%). Only 20% of elderly patients (75+) received RT6mo. The proportion of cancer patients that received RT6mo increased markedly between 1988-1992 and 1998-2002 for patients with prostate cancer (15 and 28%, respectively), rectal cancer (33 and 43%) and brain tumours (48 and 67%). The absolute number of irradiated breast cancer patients increased 30% between 1988 and 2002. Among patients with rectal cancer, a shift occurred from postoperative to preoperative RT since 1995. The percentage of irradiated patients with stage I endometrial cancer decreased from 47% in 1988-1992 to 15% in 1998-2002. Conclusions: The percentage of cancer patients who received primary RT remained stable throughout 1988-2002, being consistently lower for older patients. The increased number of irradiated patients was due mainly to earlier detection and the ageing of the population. To clarify the overall percentage of patients irradiated, population-based studies on RT given after 6 months since diagnosis are warranted.

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