Changes in use of radiotherapy for lung cancer - A Norwegian population-based study from 2000 until 2020.

Background: Radiotherapy (RT) is an important treatment modality for cancer. It requires significant resources, building facilities takes time, and planning of the capacity is essential to offer RT to all patients in need. There have been considerable advances in lung cancer management, especially medical treatment, and survival the last decades, which might impact the need for RT. In this study, we investigated whether the RT use for lung cancer has changed in Norway since year 2000.

Methods: Data on patients diagnosed with lung cancer between 2000 and 2020 were collected from the Cancer Registry of Norway, containing nearly complete RT and survival data.

Results: 55,048 patients were analyzed. Median age was 71 years, 44 % were women, 74 % had non-small-cell lung cancer, 16 % small-cell lung cancer, 10 % unknown histology, 46 % metastatic disease. Overall, 50 % received any RT. The proportion receiving curative RT increased (2000: 10 %, 2020: 22 %), mainly due to implementation of stereotactic body RT (<1% before 2008, 11 % in 2020). The proportion receiving palliative RT increased the first decade (2000: 30 %, 2010: 42 %) before decreasing to 30 % in 2020, mainly due to less use of palliative thoracic and whole-brain RT. Number of RT courses per year increased (from 1283 to 2328), courses per patient decreased the last decade (from 0.82 to 0.76). Median overall survival improved significantly (2000-2004: 6.2 months, 2016-2020: 14.0 months, p < 0.001).

Conclusion: There was a shift towards more curative and less palliative RT from 2000 until 2020. Overall, the use of RT for lung cancer increased during this period.