Algorithms to identify radiotherapy intent in unresected non-metastatic non-small-cell lung cancer: an I-O Optimise analysis
Creators: name: Ralphs, Eleanor
name: Rault, Caroline
name: Calleja, Alan
name: Daumont, Melinda J
name: Penrod, John R
name: Thompson, Matthew
name: Cheeseman, Sue
name: Soares, Marta
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Pharmacology
subject: Biotechnology
subject: Immunology
subject: FOS: Clinical medicine
subject: Mathematical Sciences not elsewhere classified
subject: Developmental Biology
subject: Cancer
subject: Hematology

description: This study aimed to develop and evaluate the performance of algorithms for identifying radiotherapy (RT) treatment intent in real-world data from patients with non-metastatic non-small-cell lung cancer (NSCLC). Using data from IPO-Porto hospital (Portugal) and the REAL-Oncology database (England), three algorithms were developed based on available RT information (#1: RT duration, #2: RT duration and type, #3: RT dose) and tested versus reference datasets. Study results showed that all three algorithms had good overall accuracy (91–100%) for patients receiving RT plus systemic anticancer therapy (SACT) and algorithms #2 and #3 also had good accuracy (&gt;99%) for patients receiving RT alone. These algorithms could help classify treatment intent in patients with NSCLC receiving RT with or without SACT in real-world settings where intent information is missing/incomplete. One objective of many real-world studies is to evaluate which cancer treatments are given during routine visits to hospitals or cancer centers and assess how well the treatments work. This objective is easier to achieve when we know the reason for the cancer treatment (known as treatment intent), but doctors often do not record whether the treatment was given to actively treat the cancer (curative intent) or to slow down a cancer's growth or control symptoms in people with incurable cancer (palliative intent). In this article, we describe the development and testing of algorithms to determine treatment intent in people with lung cancer given radiotherapy (the controlled application of radiation to cancer cells). These algorithms involve following a step-by-step process based on three key questions: for how long was the radiotherapy given? what type of radiotherapy was given? and what dose of radiotherapy was given? Answers were then tested true or false against reference answers provided by doctors who know a lot about radiotherapy. We found that all three algorithms were able to determine the correct treatment intent in more than nine out of ten people given radiotherapy with systemic anticancer therapy (e.g., chemotherapy) and two algorithms were able to determine the correct treatment intent in more than nine out of ten people given radiotherapy alone. These algorithms may be helpful in determining treatment intent in people given radiotherapy to treat lung cancer in real-world settings, and may help us learn more about real-world lung cancer treatment. A proportion of patients with non-metastatic non-small-cell lung cancer (NSCLC) are unable or unwilling to undergo surgical tumor resection and are considered ‘inoperable’. For these inoperable patients, European guidelines have long recommended initial treatment with potentially curative radiotherapy (RT)-based therapies. However, many patients diagnosed with non-metastatic NSCLC in real-world settings may be seen as unsuitable for curative-intent RT and may receive palliative-intent RT or chemoradiotherapy instead. When evaluating real-world NSCLC treatment patterns in retrospective database analyses, differentiating between patients with non-metastatic disease who received curative-intent versus palliative-intent RT-based therapy is often challenging as the defined treatment intent is rarely prospectively captured. Using data from IPO-Porto hospital in Portugal and the REAL-Oncology database in England, three algorithms were developed and tested for their ability to identify RT treatment intent in patients with non-metastatic NSCLC. The tested algorithms based on RT duration only, RT duration and type and RT dose had good performance in patients receiving RT + systemic anticancer therapy (SACT). The algorithms based on RT duration and type or on RT dose also showed good performance in patients receiving RT alone, but the algorithm based only on RT duration showed poor performance in these patients. The results suggest that these algorithms could help classify treatment intent in patients with NSCLC receiving RT ± SACT in real-world settings where intent information is missing or incomplete. The use of these algorithms to identify patients with non-metastatic NSCLC receiving curative versus palliative RT-based therapies may help improve our understanding of current treatment practices and related outcomes in the non-metastatic NSCLC setting.