PD12-07 DECLINE IN THE USE OF RADIATION FOR STAGE I SEMINOMA: ANALYSIS OF THE NATIONAL CANCER DATABASE (2015)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2015PD12-07 DECLINE IN THE USE OF RADIATION FOR STAGE I SEMINOMA: ANALYSIS OF THE NATIONAL CANCER DATABASE Nikhil Waingankar, Elizabeth Handorf, Marc Smaldone, Elizabeth Plimack, Yu-Ning Wong, Mohammed Haseebuddin, Eric Horwitz, Robert Uzzo, and Alexander Kutikov Nikhil WaingankarNikhil Waingankar More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Elizabeth PlimackElizabeth Plimack More articles by this author , Yu-Ning WongYu-Ning Wong More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Eric HorwitzEric Horwitz More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1059AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Historically, primary radiotherapy has been the preferred treatment modality for stage I seminoma. However, there is emerging consensus that observation or primary chemotherapy may be the preferred management strategies to reduce overtreatment and risk of secondary malignancy. Hypothesizing that the use of radiotherapy has decreased in the modern era, our objective was to assess temporal practice patterns in stage I seminoma using a large national cancer registry. METHODS The National Cancer Database (NCDB) was queried for all patients diagnosed with stage I seminoma from 1998 to 2011. Temporal trends for receipt of systemic chemotherapy, radiation, and observation (defined as no treatment) were assessed. Following adjustment for patient, demographic, and clinicopathologic characteristics, generalized estimating equations were used to assess for associations between covariates and receipt of primary radiotherapy. RESULTS Of the 34,251 patients identified with stage I seminoma in the NCDB, 20,627 were treated with radiation (60.2%), 2,278 were treated with chemotherapy (6.7%), and 11,346 were managed with observation (33.1%). Radiation use significantly declined from 73.5% in 1998 to 29.6% in 2011 (p<0.0001), while utilization of chemotherapy (1.9% to 16.5%, p<0.0001) and observation (24.6% to 53.9%, p<0.0001) markedly increased (FIGURE 1). Following adjustment, age categories 30−39 years (OR 1.06 [CI 1.01−1.13]) and 40−49 years (OR 1.10 [CI 1.03−1.17]), pathologic stage T2 (OR 1.25 [CI 1.17−1.32]) and T3 (OR 1.21 [CI 1.04−1.41]), and facilities located in the East (IL, IN, MI, OH, WI; OR 1.59 [CI 1.32-1.92]) and West North Central states (IA, KS, MN, MO, ND, SD, NE; OR 1.82 [CI 1.44-2.28]) were associated with increased utilization of radiotherapy. Uninsured patients (OR 0.78 [CI 0.71−0.86]) and those with Medicaid (OR 0.82 [CI 0.73−0.92]) or Medicare (OR 0.62 [CI 0.55−0.69]) were less likely to undergo primary radiotherapy. CONCLUSIONS Utilization of radiation therapy for stage I seminoma is on the decline. Coinciding with shifts in evidence−based guidelines, observation is now the most commonly employed management strategy for patients with Stage I seminoma. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e258-e259 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Nikhil Waingankar More articles by this author Elizabeth Handorf More articles by this author Marc Smaldone More articles by this author Elizabeth Plimack More articles by this author Yu-Ning Wong More articles by this author Mohammed Haseebuddin More articles by this author Eric Horwitz More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...