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Díaz JFR. Cost analysis of three-dimensional radiation therapy versus intensity-modulated chemoradiotherapy for locally advanced cervical cancer in Peruvian citizens. Ecancermedicalscience 2023; 17:1531. [PMID: 37138970 PMCID: PMC10151083 DOI: 10.3332/ecancer.2023.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Indexed: 05/05/2023] Open
Abstract
Background and objectives The standard treatment for locally advanced cervical cancer (CC) is chemoradiotherapy (CTRT) followed by high-dose-rate brachytherapy (HDRBT). The ideal scenario would be under novel intensity-modulated radiation therapy (IMRT) volumetric-modulated arc therapy (VMAT) radiation techniques over three-dimensional (3D) radiation therapy. However, radiotherapy (RT) centres in low- and middle-income countries have limited equipment for teletherapy services like HDRBT. This is why the 3D modality is still in use. The objective of this study was to analyse costs in a comparison of 3D versus IMRT versus VMAT based on clinical staging. Materials and methods From 02/01/2022 to 05/01/2023 a prospective registry of the costs for oncological management was carried out for patients with locally advanced CC who received CTRT ± HDRBT. This included the administration of radiation with chemotherapy. The cost associated with patient and family transfers and hours in the hospital was also identified. These expenses were used to project the direct and indirect costs of 3D versus IMRT versus VMAT. Results The treatment regimens for stage IIIC2, including 3D and novel techniques, are those with the highest costs. The administration of 3D RT for IIIC2 and novel IMRT or VMAT techniques, is $3,881.69, $3,374.76, and $2,862.80, respectively. The indirect cost from stage IIB to IIIC1 in descending order is IMRT, 3D and VMAT, but in IIIC2 the novel technique regimens reduce by up to 33.99% compared to 3D. Conclusion In RT centres with an available supply of RT equipment, VMAT should be preferred over IMRT/3D since it reduces costs and toxicity. However, in RT centres where demand exceeds supply in the VMAT technique planning systems, the use of 3D teletherapy over IMRT/VMAT could continue to be used in patients with stage IIB to IIIC1.
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Affiliation(s)
- José Fernando Robles Díaz
- Regional Institute for Neoplastic Diseases, Central Region, Concepción, Junín 12126, Peru and Los Andes Peruvian University, Huancayo 12002, Peru
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Pujade-Lauraine E, Tan DSP, Leary A, Mirza MR, Enomoto T, Takyar J, Nunes AT, Chagüi JDH, Paskow MJ, Monk BJ. Comparison of global treatment guidelines for locally advanced cervical cancer to optimize best care practices: A systematic and scoping review. Gynecol Oncol 2022; 167:360-372. [PMID: 36096973 DOI: 10.1016/j.ygyno.2022.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Survival outcomes for cervical cancer differ between countries and world regions. Locally advanced cervical cancer (LACC) is associated with poorer outcomes than early-stage disease. Country-specific variations in diagnostic and treatment recommendations might contribute to differences in LACC outcomes among countries. OBJECTIVE We compared international and country-specific guidelines for LACC diagnostic imaging and treatment recommendations. METHODS A systematic literature review and targeted search were used to identify cervical cancer treatment guidelines published between January 1999-August 2021. Guidelines were identified via literature databases, health technology assessment databases, disease-specific websites, and health organization websites. The targeted search included guidelines from countries in regions known to have high cervical cancer prevalence or mortality. Non-English guidelines were translated by native speakers or online translation services. RESULTS Forty-six guidelines from 31 countries, regions, and international organizations were compared (41/46 using staging criteria, 27 of which used 2009 FIGO). Most guidelines recommended imaging tests for diagnosis and staging. Chest X-ray, intravenous pyelogram, CT, and MRI were commonly recommended for diagnosis and staging while MRI and PET-CT were recommended for the assessment of lymph node status and distant metastases, with a preference for PET-CT over MRI. There was global consensus for cisplatin-based concurrent chemoradiation as primary treatment for stages IIB to IVA, with few exceptions. Treatment recommendations for stages IB2 to IIA2 varied. Most guidelines agreed on adjuvant concurrent chemoradiation after radical hysterectomy when there is a high recurrence risk, and adjuvant radiotherapy when there is an intermediate recurrence risk. Recommendations for other adjuvant and neoadjuvant therapies varied among the guidelines. CONCLUSIONS Differences among treatment guidelines by LACC stage might be influenced by staging criteria used, resource availability, and prevention program effectiveness. Addressing these areas may unify guidelines and improve global outcomes. Review and update of guidelines will be important as novel LACC therapies become available.
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Affiliation(s)
- Eric Pujade-Lauraine
- ARCAGY-GINECO, Medical Oncology, 1, place du Parvis-Notre-Dame, 75181 Paris, France.
| | - David S P Tan
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, Cancer Science Institute of Singapore, National University of Singapore, Singapore 119074, Singapore.
| | - Alexandra Leary
- Gustave Roussy Cancer Center, INSERM U981, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Gynecological Unit, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København, Denmark.
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi Campus 757 Ichibancho, Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
| | - Jitender Takyar
- Parexel International, Evidence Evaluation HEOR, DLF Building, Tower F, 2nd Floor, Chandigarh Technology Park, Chandigarh 160101, India.
| | - Ana Tablante Nunes
- Merck, 126 East Lincoln Avenue, P.O. Box 2000, Rahway, NJ 07065, United States of America..
| | | | - Michael J Paskow
- AstraZeneca, Global Medical Affairs, 1 Medimmune Way, Gaithersburg, MD 20878, United States of America..
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School, 350 West Thomas Road, Phoenix, AZ 85013, United States of America..
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Mayadev JS, Ke G, Mahantshetty U, Pereira MD, Tarnawski R, Toita T. Global challenges of radiotherapy for the treatment of locally advanced cervical cancer. Int J Gynecol Cancer 2022; 32:436-445. [PMID: 35256434 PMCID: PMC8921593 DOI: 10.1136/ijgc-2021-003001] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Cervical cancer represents a significant portion of the global cancer burden for women, with low- and middle-income countries carrying the bulk of this burden. Additionally, underserved populations in countries with sufficient resources may have a higher incidence of cervical cancer and poorer outcomes. Concurrent chemoradiotherapy is the standard-of-care treatment for locally advanced cervical cancer, which includes patients with stage IB3 to IVA disease, and it is effective for many patients; however, cervical cancer-related mortality remains high. The critical nature of cervical cancer treatment is underscored by the recent launch of the World Health Organization global initiative to accelerate the elimination of cervical cancer using a triple-intervention strategy of increased vaccination, screening, and treatment. The initiative calls for 90% of all patients diagnosed with cervical cancer to receive the appropriate treatment, but to reach this global goal there are significant barriers related to radiotherapy that must be addressed. We discuss and review evidence of the lack of adherence to guideline-recommended treatment, brachytherapy underutilization, limited access to radiotherapy in low- and middle-income countries, as well as regional limitations within high-income countries, as the major barriers to radiotherapy treatment for locally advanced cervical cancer. We further review ways these barriers are currently being addressed and, in some cases, make additional recommendations to address these issues. Finally, despite receiving recommended treatments, many patients with locally advanced cervical cancer have a poor prognosis. With effective administration of current standards of care, the global community will be able to shift focus to advancing treatment efficacy for these patients. We review several types of therapies under clinical investigation that are additions to concurrent chemoradiotherapy, including immune checkpoint inhibitors, antiangiogenic agents, DNA repair inhibitors, human papillomavirus vaccines, and radiosensitizing nanoparticles.
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Affiliation(s)
- Jyoti S Mayadev
- University of California San Diego, La Jolla, California, USA
| | - Guihao Ke
- Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Umesh Mahantshetty
- Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, Andhra Pradesh, India
| | | | - Rafal Tarnawski
- Maria Skłodowska-Curie Memorial Cancer Center, Gliwice, Poland
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
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Pilleron S, Cabasag CJ, Ferlay J, Bray F, Luciani S, Almonte M, Piñeros M. Cervical cancer burden in Latin America and the Caribbean: Where are we? Int J Cancer 2020; 147:1638-1648. [PMID: 32150288 DOI: 10.1002/ijc.32956] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 12/24/2022]
Abstract
In May 2018, the World Health Organization (WHO) called for the elimination of cervical cancer. To monitor this initiative, we examined cervical cancer incidence and mortality in the Latin America and Caribbean (LAC) region using GLOBOCAN 2018, Cancer Incidence in Five Continents Series, and the WHO Mortality Database. We estimated the number of cases and age-standardized rates (ASRs) for cervical cancer incidence and mortality for 2018. We also presented the ASRs for recorded cervical cancer incidence from the period 2008 to 2012. We calculated annual rates and analyzed trends in cervical cancer incidence and mortality for all ages combined and for the following age groups: 0-29, 30-49, 50-64 and 65+. Finally, we calculated the estimated average annual percentage change in incidence and mortality rates for the past 10 years. In 2018, an estimated 56,000 new cervical cancer cases and 28,000 cervical cancer deaths occurred among women in LAC with great variations between subregions and countries/territories. Overall, trends in cervical cancer incidence and mortality have decreased over the past decade; however, the rates are still above the elimination threshold of 4 per 100,000 in most LAC countries/territories. Despite the encouraging trends observed, achieving the elimination of cervical cancer in the region still requests substantial political commitment and economic effort. Population-based cancer registries are critical in monitoring the elimination initiative.
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Affiliation(s)
- Sophie Pilleron
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Citadel J Cabasag
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Silvana Luciani
- Unit of Non-communicable Diseases, Violence and Injuries Prevention, PAHO, Washington, District of Columbia, USA, USA
| | - Maribel Almonte
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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