Trends and variation in the use of radiotherapy in non-metastatic prostate cancer: a 12-year nationwide overview from The Netherlands

Purpose: This population-based study describes nationwide trends and variation in the use of primary radiotherapy for non-metastatic prostate cancer in The Netherlands in 2008-2019. Methods: Prostate cancer patients were selected from the Netherlands Cancer Registry (N=103,059). Treatment trends were studied over time by prognostic risk groups. Multilevel analyses were applied to identify variables associated with external beam radiotherapy (EBRT) and brachy-monotherapy versus no active treatment in low-risk disease, and EBRT versus radical prostatectomy in intermediate and high-risk disease. Results: EBRT use remained stable (5-6%) in low-risk prostate cancer and increased from 21% to 32% in intermediate-risk, 37% to 45% in high-risk localized and 50% to 57% in high-risk locally advanced disease. Brachy-monotherapy decreased from 19% to 6% and from 15% to 10% in low and intermediate-risk disease, respectively, coinciding an increase of no active treatment from 55% to 73% in low-risk disease. Use of EBRT or brachy-monotherapy versus no active treatment in low-risk disease differed by region, T-stage and patient characteristics. Hospital characteristics were not associated with treatment in low-risk disease, except for availability of brachy-monotherapy in 2008-2013. Age, number of comorbidities, travel time for EBRT, prognostic risk group, and hospital characteristics were associated with EBRT versus prostatectomy in intermediate and high-risk disease. Conclusion: Intermediate/high-risk PCa was increasingly managed with EBRT, while brachy-monotherapy in low/intermediate-risk PCa decreased. In low-risk PCa, the no active treatment-approach increased. Variation in treatment suggests treatment decision related to patient/disease characteristics. In intermediate/high-risk disease, variation seems furthermore related to the treatment modalities available in the diagnosing hospitals

A stone wall out of the earth that thundering cannon cannot destroy: bastion and moat at the Castle, Cape Town

Although the urgency with which the Dutch East India Company administration at the Cape built defensive works was a direct result of their fear of attack from both land and sea, there was an additional imperative, for the Castle at Cape Town stood as a symbol of Dutch colonial aspirations. In this paper, we compare written and material texts of one part of the Castle's architecture to show firstly, how the discordances between such sources can reveal an underside of early colonization and secondly, how the Castle moat, in the seventeenth century a stamp of aspirant power, was by the mid-nineteenth century a dump and a public nuisance