Most older patients with indolent lymphoma were treated with long-course radiation therapy (LC-RT) rather than the short-course RT (SC-RT) recommended during the COVID-19 pandemic, according to the results of the phase 3 A-LONG trial published in JAMA Health Forum.

During the COVID-19 pandemic, emergency RT guidelines recommended the use of SC-RT to reduce the risk of exposure to SARS-CoV-2. The aim of this study was to evaluate the adoption of SC-RT among Medicare beneficiaries.

The single-center, cross-sectional study evaluated data from 10,447 radiation episodes conducted between 2015 and 2019. All patients were at least age 65 and had indolent lymphoma not treated with systemic therapy.

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The majority of radiation episodes were with conventional RT at 78%. From 2015 to 2019, the use of IMRT increased from 17% to 25% (P <.001).

LC-RT was used more commonly than SC-RT, with SC-RT administered to 29% of patients. The use of SC-RT was significantly associated with age 85 or older (odds ratio [OR], 2.18; 95% CI, 1.94-2.45), hospital-affiliated rather than free-standing care (OR, 1.74; 95% CI, 1.57-1.93), and use of conventional RT rather than IMRT (OR, 5.18; 95% CI, 4.45-6.02).

The cost of SC-RT was lower at $4279 compared with $8484 for LC-RT. IMRT was associated with higher costs at $8048 compared with $4121 with conventional RT for SC-RT.

“Use of LC-RT has important financial implications given higher total spending,” the authors wrote in their report. “Wider adoption of SC-RT may help reduce systemwide costs and optimize personalized RT decision-making.”


Tringale KR, Hubbeling H, Chino F, et al. Trends in use of and Medicare spending on short-course radiotherapy for lymphomas from 2015 to 2019. JAMA Health Forum. 2022;3:e221815. doi: 10.1001/jamahealthforum.2022.1815