Chapter 7: A Prospective Survey of Radiotherapy in Sweden

Abstract

A prospective survey was conducted of patients who began radiotherapy in Sweden during 12 weeks in the autumn of 1992. All hospitals that provided radiotherapy participated. The goal was to study the most common diagnoses, corresponding to approximately 80% of the patients. A special analysis involving all patients who started radiotherapy in 1992 at Sweden's largest unit, Radiumhemmet in Stockholm, revealed that the goal had been achieved. Overall, the assessment showed the data to be representative and of good quality.

The analysis included 2 988 patients, of whom 2 776 received external radiotherapy alone, 63 received both external radiotherapy and brachytherapy, and the remaining 149 received brachytherapy alone. As expected, the two most common diagnoses were breast cancer and prostate cancer. To evaluate the total number of patients receiving radiotherapy in Sweden in 1992, the results of the study were related to the results of the economic assessment from 1991 described in Chapter 8. The assessment shows that approximately 13000 patients began radiotherapy in Sweden in 1992, ie, almost one third of cancer patients receive radiotherapy at some time during the course of their disease.

The mean age of radiotherapy patients was 64 years, and 55% of all patients were women. Half of the patients received curative treatment, and the other half palliative treatment. The proportion of curative treatments varied considerably among the departments, from 23% to 86%. The proportion was 39% at county departments, compared to 52% at regional departments, and 76% at the gynecologic oncology departments. Palliative treatment was usually provided by less complicated methods, using fewer fractions and fewer fields. The proportion of curative fractions was 68%, and the proportion of curative fields was 72%. The proportion of curative treatments also varied greatly among different diagnostic groups, from 82% for head and neck cancer to 17% for lung and prostate cancer. Of patients receiving primary treatment, one third received radiotherapy alone and the remainder received a combination of radiotherapy and other treatment, usually surgery. Thirty-three percent of the patients were treated in accordance with clinical protocols or studies, with a somewhat higher proportion of these patients at the gynecologic oncology departments. The figures varied between 82% for gastrointestinal cancer and 11% for prostate cancer.

Curative treatment was delivered, on average, using 23 fractions, 2.6 fields, and 49 Gy. The highest dosage, most fractions, and most fields were delivered for prostate cancer and head and neck cancer. The lowest doses were given for malignant lymphoma. Corresponding figures for palliative treatment were 11 fractions, 2.0 fields, and 30 Gy. Of patients receiving palliative therapy, 60% were treated for bone metastases. These patients were treated with 8 fractions, 1.7 fields, and 27 Gy. With regard to curative and palliative treatment alike, there was a tendency for regional departments to give more fractions and higher doses than the county departments.

No differences in sex or age appeared regarding the number of fractions, the number of fields, and the dose, except in patients over age 85 years where lower figures reflected a higher proportion of palliative treatments.

With one exception only, patients with gynecologic cancer were the ones who received brachytherapy. Seventy percent of the patients had cancer in the body of the uterus. They received an average of four treatments, three for those who also received external radiotherapy. The number of brachytherapy treatments varied widely by department. This can be explained by two different therapeutic traditions: one tradition uses agents with low radiation intensity per time unit, resulting in fewer and longer treatments, and the second tradition involves agents with high radiation intensity per time unit, resulting in more, although shorter, treatments.