Socioeconomic and ethnic disparities in radiation therapy utilization for primary bone diffuse large B-cell lymphoma: A SEER population-based study.

BACKGROUND

Primary bone diffuse large B-cell lymphoma (PB-DLBCL) is a rare extranodal lymphoma in which consolidative radiation therapy (RT) has demonstrated survival benefit, particularly in early-stage disease. Disparities in access to radiation oncology services have been documented across multiple malignancies. This study evaluated national patterns of RT utilization in PB-DLBCL and identified demographic and socioeconomic factors associated with RT receipt.

METHODS

Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with PB-DLBCL between 2000 and 2015. Patients with bone as the primary site and known Ann Arbor stage were included. RT utilization was compared using chi-square and Fisher's exact tests, and multivariable logistic regression identified factors independently associated with RT receipt in overall and stage-stratified analyses.

RESULTS

Of 1454 patients meeting inclusion criteria, 824 (56.7%) received RT. On multivariable analysis, Hispanic ethnicity (aOR 0.64, 95% CI 0.46-0.90; p = 0.010) and lower household income (aOR 0.72, 95% CI 0.56-0.93; p = 0.013) were independently associated with decreased RT receipt. Patients aged 40-70 and 70 + years were more likely to receive RT than those under 40. In stage-stratified analyses, disparities by Hispanic ethnicity (aOR 0.58; p = 0.013) and lower income (aOR 0.55; p < 0.001) were most pronounced in early-stage disease and nonsignificant in advanced-stage disease.

CONCLUSIONS

Significant socioeconomic and ethnic disparities exist in RT utilization among PB-DLBCL patients, particularly in early-stage disease where RT confers established benefit. These findings underscore the need for targeted interventions addressing structural barriers to guideline-concordant radiation therapy.

LEVEL OF EVIDENCE: III.