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Winter RC, Amghar M, Wacker AS, Bakos G, Taş H, Roscher M, Kelly JM, Benešová-Schäfer M. Future Treatment Strategies for Cancer Patients Combining Targeted Alpha Therapy with Pillars of Cancer Treatment: External Beam Radiation Therapy, Checkpoint Inhibition Immunotherapy, Cytostatic Chemotherapy, and Brachytherapy. Pharmaceuticals (Basel) 2024; 17:1031. [PMID: 39204136 PMCID: PMC11359268 DOI: 10.3390/ph17081031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 09/03/2024] Open
Abstract
Cancer is one of the most complex and challenging human diseases, with rising incidences and cancer-related deaths despite improved diagnosis and personalized treatment options. Targeted alpha therapy (TαT) offers an exciting strategy emerging for cancer treatment which has proven effective even in patients with advanced metastatic disease that has become resistant to other treatments. Yet, in many cases, more sophisticated strategies are needed to stall disease progression and overcome resistance to TαT. The combination of two or more therapies which have historically been used as stand-alone treatments is an approach that has been pursued in recent years. This review aims to provide an overview on TαT and the four main pillars of therapeutic strategies in cancer management, namely external beam radiation therapy (EBRT), immunotherapy with checkpoint inhibitors (ICI), cytostatic chemotherapy (CCT), and brachytherapy (BT), and to discuss their potential use in combination with TαT. A brief description of each therapy is followed by a review of known biological aspects and state-of-the-art treatment practices. The emphasis, however, is given to the motivation for combination with TαT as well as the pre-clinical and clinical studies conducted to date.
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Affiliation(s)
- Ruth Christine Winter
- Research Group Molecular Biology of Systemic Radiotherapy/Translational Radiotheranostics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (R.C.W.); (M.A.); (G.B.); (H.T.)
| | - Mariam Amghar
- Research Group Molecular Biology of Systemic Radiotherapy/Translational Radiotheranostics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (R.C.W.); (M.A.); (G.B.); (H.T.)
| | - Anja S. Wacker
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, 413 East 69th Street, New York, NY 10021, USA; (A.S.W.); (J.M.K.)
| | - Gábor Bakos
- Research Group Molecular Biology of Systemic Radiotherapy/Translational Radiotheranostics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (R.C.W.); (M.A.); (G.B.); (H.T.)
| | - Harun Taş
- Research Group Molecular Biology of Systemic Radiotherapy/Translational Radiotheranostics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (R.C.W.); (M.A.); (G.B.); (H.T.)
| | - Mareike Roscher
- Service Unit for Radiopharmaceuticals and Preclinical Studies, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
| | - James M. Kelly
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, 413 East 69th Street, New York, NY 10021, USA; (A.S.W.); (J.M.K.)
| | - Martina Benešová-Schäfer
- Research Group Molecular Biology of Systemic Radiotherapy/Translational Radiotheranostics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (R.C.W.); (M.A.); (G.B.); (H.T.)
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Swain M, Budrukkar A, Rembielak A, Kron T, Agarwal JP. Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00205-4. [PMID: 37302881 DOI: 10.1016/j.clon.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - T Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India.
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Abdel-Wahab M, Gondhowiardjo SS, Rosa AA, Lievens Y, El-Haj N, Polo Rubio JA, Prajogi GB, Helgadottir H, Zubizarreta E, Meghzifene A, Ashraf V, Hahn S, Williams T, Gospodarowicz M. Global Radiotherapy: Current Status and Future Directions-White Paper. JCO Glob Oncol 2021; 7:827-842. [PMID: 34101482 PMCID: PMC8457786 DOI: 10.1200/go.21.00029] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million deaths in 2018 was attributed to this noncommunicable disease, making it the second leading cause of death worldwide. Left unchecked, this will further increase in scale, with an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040. Although it is known and generally accepted that cancer services must include radiotherapy, such access is still very limited in many parts of the world, especially in low- and middle-income countries. After thorough review of the current status of radiotherapy including programs worldwide, as well as achievements and challenges at the global level, the International Atomic Energy Agency convened an international group of experts representing various radiation oncology societies to take a closer look into the current status of radiotherapy and provide a road map for future directions in this field. It was concluded that the plethora of global and regional initiatives would benefit further from the existence of a central framework, including an easily accessible repository through which better coordination can be done. Supporting this framework, a practical inventory of competencies needs to be made available on a global level emphasizing the knowledge, skills, and behavior required for a safe, sustainable, and professional practice for various settings. This white paper presents the current status of global radiotherapy and future directions for the community. It forms the basis for an action plan to be developed with professional societies worldwide.
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Affiliation(s)
- May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Soehartati S Gondhowiardjo
- Radiotherapy Department, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas of Indonesia, Jakarta, Indonesia
| | - Arthur Accioly Rosa
- Radiation Oncology, Hospital Portugues, Hospital Sao Rafael, Salvador, Brazil
| | | | - Noura El-Haj
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | | | | | - Herdis Helgadottir
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarreta
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ahmed Meghzifene
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Varisha Ashraf
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Stephen Hahn
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Tim Williams
- South Florida Proton Therapy Institute, Delray Beach, FL
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Marta GN, Ramiah D, Kaidar-Person O, Kirby A, Coles C, Jagsi R, Hijal T, Sancho G, Zissiadis Y, Pignol JP, Ho AY, Cheng SHC, Offersen BV, Meattini I, Poortmans P. The Financial Impact on Reimbursement of Moderately Hypofractionated Postoperative Radiation Therapy for Breast Cancer: An International Consortium Report. Clin Oncol (R Coll Radiol) 2021; 33:322-330. [PMID: 33358283 DOI: 10.1016/j.clon.2020.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022]
Abstract
AIMS Moderately hypofractionated breast irradiation has been evaluated in several prospective studies, resulting in wide acceptance of shorter treatment protocols for postoperative breast irradiation. Reimbursement for radiation therapy varies between private and public systems and between countries, impacting variably financial considerations in the use of hypofractionation. The aim of this study was to evaluate the financial impact of moderately hypofractionated breast irradiation by reimbursement system in different countries. MATERIALS AND METHODS The study was designed by an international group of radiation oncologists. A web-questionnaire was distributed to representatives from each country. The participants were asked to involve the financial consultant at their institution. RESULTS Data from 13 countries from all populated continents were collected (Europe: Denmark, France, Italy, the Netherlands, Spain, UK; North America: Canada, USA; South America: Brazil; Africa: South Africa; Oceania: Australia; Asia: Israel, Taiwan). Clinicians and/or departments in most of the countries surveyed (77%) receive remuneration based on the number of fractions delivered to the patient. The financial loss per patient estimated resulting from applying moderately hypofractionated breast irradiation instead of conventional fractionation ranged from 5-10% to 30-40%, depending on the healthcare provider. CONCLUSION Although a generalised adoption of moderately hypofractionated breast irradiation would allow for a considerable reduction in social and economic burden, the financial loss for the healthcare providers induced by fee-for-service remuneration may be a factor in the slow uptake of these regimens. Therefore, fee-for-service reimbursement may not be preferable for radiation oncology. We propose that an alternative system of remuneration, such as bundled payments based on stage and diagnosis, may provide more value for all stakeholders.
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Affiliation(s)
- G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - D Ramiah
- Department of Radiation Oncology, Donald Gordon Medical Centre, Johannesburg, South Africa
| | - O Kaidar-Person
- Breast Cancer Radiation Unit, Radiation Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - A Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - C Coles
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - R Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - T Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montréal, Quebec, Canada
| | - G Sancho
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Y Zissiadis
- Department of Radiation Oncology, Genesis Cancer Care, Wembley, WA, Australia
| | - J-P Pignol
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - S H-C Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - B V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - I Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Biomedical, Experimental, and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - P Poortmans
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
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Barton M, Batumalai V, Spencer K. Health Economic and Health Service Issues of Palliative Radiotherapy. Clin Oncol (R Coll Radiol) 2020; 32:775-780. [DOI: 10.1016/j.clon.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
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Guo C, Huang P, Li Y, Dai J. Accurate method for evaluating the duration of the entire radiotherapy process. J Appl Clin Med Phys 2020; 21:252-258. [PMID: 32710490 PMCID: PMC7497908 DOI: 10.1002/acm2.12959] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND PURPOSE Along with the increasing demand for high-quality radiotherapy and the growing number of high-precision radiotherapy devices, precise radiotherapy workflow management and accurate time evaluation of the entire radiotherapy process are crucial to providing appropriate, timely treatment for cancer patients. This study therefore aimed to establish an accurate, reliable method for evaluating the duration of the radiotherapy process, from beginning to end, based on real-time measurement data. These data are vital for improving the quality and efficiency of radiotherapy delivery. MATERIALS AND METHODS Altogether, 17 620 cancer patients' radiotherapy experiences were measured in real time in our radiation oncology department. The process was divided into five sequential core modules, with the start and stop times of each module automatically recorded using MOSAIQ software, an automated radiotherapy management system. The duration for each module and the total duration of the entire process were then automatically calculated and qualitatively analyzed. RESULTS The analysis showed significant treatment-time differences depending on the tumor site, which provided a practical reference for improvement of previous treatment modules and appointments management. In all, >60% of the cancer patients' total treatment time could be shortened. CONCLUSIONS We established a reliable method for evaluating the overall duration of radiotherapy protocols. The results pointed out a clear pathway by which we could improve future radiotherapy workflow management and appointment systems.
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Affiliation(s)
- Chenlei Guo
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Peng Huang
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yexiong Li
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianrong Dai
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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How public health services pay for radiotherapy in Europe: an ESTRO–HERO analysis of reimbursement. Lancet Oncol 2020; 21:e42-e54. [DOI: 10.1016/s1470-2045(19)30794-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
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Medenwald D, Vordermark D, Dietzel CT. Number of radiotherapy treatment machines in the population and cancer mortality: an ecological study. Clin Epidemiol 2018; 10:1249-1273. [PMID: 30288122 PMCID: PMC6163015 DOI: 10.2147/clep.s156764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives The aim of this study was to assess the association between the number of radiotherapy treatment machines (RTMs) in the population and incidence-adjusted cancer mortality. Methods Data on cancer incidence and mortality were obtained from the GLOBOCAN project (only high-quality data, C3, or higher according to GLOBOCAN quality label), information on the number of RTMs from the Directory of Radiotherapy Centers database, and remaining data from the World Bank and World Health Organization database. We used linear regression models to assess the associations between RTM per 10,000,000 inhabitants (logarithmized) and the log-transformed mortality/incidence ratio. Models were adjusted for public health variables. To assess the bias due to unobserved confounders, mortality from leukemia was considered as a negative control. Here radiotherapy treatment is less frequently applied, but a common set of confounders is shared with cancer types where radiotherapy plays a stronger role, enabling us to estimate the bias due to confounding of unmeasured parameters. To assess an exposure–effect size relationship, estimated cancer type-specific estimates were related to the proportion of subjects receiving radiotherapy. Results We found an inverse linear relationship between RTM in the population and the cancer mortality to incidence ratio for prostate cancer (14.1% per doubling of RTM; 95% CI: 0.1%–26.1%), female breast cancer (12.3%; 95% CI: 2.7%–20.9%), and lung cancer in women (11.2%; 95% CI: 4.3%–17.6%). There was no evidence for bias due to unobserved confounders after covariate adjustment. For women, an exposure-effect size relationship was found (P=0.02). Conclusion In this ecological study, we found evidence that the population density of RTM is related to cancer mortality independently of other public health parameters.
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Affiliation(s)
- Daniel Medenwald
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany, .,Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany,
| | - Dirk Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany,
| | - Christian T Dietzel
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany,
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Thompson MK, Poortmans P, Chalmers AJ, Faivre-Finn C, Hall E, Huddart RA, Lievens Y, Sebag-Montefiore D, Coles CE. Practice-changing radiation therapy trials for the treatment of cancer: where are we 150 years after the birth of Marie Curie? Br J Cancer 2018; 119:389-407. [PMID: 30061587 PMCID: PMC6117262 DOI: 10.1038/s41416-018-0201-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 12/18/2022] Open
Abstract
As we mark 150 years since the birth of Marie Curie, we reflect on the global advances made in radiation oncology and the current status of radiation therapy (RT) research. Large-scale international RT clinical trials have been fundamental in driving evidence-based change and have served to improve cancer management and to reduce side effects. Radiation therapy trials have also improved practice by increasing quality assurance and consistency in treatment protocols across multiple centres. This review summarises some of the key RT practice-changing clinical trials over the last two decades, in four common cancer sites for which RT is a crucial component of curative treatment: breast, lung, urological and lower gastro-intestinal cancer. We highlight the global inequality in access to RT, and the work of international organisations, such as the International Atomic Energy Agency (IAEA), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the United Kingdom National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad), that aim to improve access to RT and facilitate radiation research. We discuss some emerging RT technologies including proton beam therapy and magnetic resonance linear accelerators and predict likely future directions in clinical RT research.
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Affiliation(s)
- Mareike K Thompson
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | | | - Anthony J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester; The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, London, SM2 5NG, UK
| | - Robert A Huddart
- Section of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, C. Heymanslaan, 9000, Ghent, Belgium
| | - David Sebag-Montefiore
- Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds; Leeds Cancer Centre, St James's University Hospitals, Leeds, LS9 7TF, UK
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, CB2 0QQ, UK.
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Defourny N, Dunscombe P, Perrier L, Grau C, Lievens Y. Cost evaluations of radiotherapy: What do we know? An ESTRO-HERO analysis. Radiother Oncol 2017; 121:468-474. [PMID: 28007378 DOI: 10.1016/j.radonc.2016.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
Although economic evidence is becoming mandatory to support health care decision-making, challenges remain in generating high quality cost data, especially for complex and rapidly evolving treatment modalities, such as radiotherapy. The overall aim of this systematic literature review was to critically analyse the type and quality of radiotherapy cost information available in cost calculation studies, from the health care provider's perspective, published since 1981. A selection process, based on strict and explicit criteria, yielded 52 articles. In spite of meeting our criteria these studies displayed large heterogeneity in scope, costing method, inputs and outputs. The limited use of conventional costing methodologies along with insufficient information on resource inputs hampered comparability across studies. A consistent picture of radiotherapy costs, based on methodologically sound costing studies, has yet to emerge. These results call for developing a well-defined and generally accepted cost methodology for performing economic evaluation studies in radiotherapy.
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Affiliation(s)
- Noémie Defourny
- European Society for Radiotherapy and Oncology, Brussels, Belgium.
| | | | - Lionel Perrier
- Centre Régional de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital, Ghent, Belgium
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11
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Zaorsky NG, Davis BJ, Nguyen PL, Showalter TN, Hoskin PJ, Yoshioka Y, Morton GC, Horwitz EM. The evolution of brachytherapy for prostate cancer. Nat Rev Urol 2017; 14:415-439. [PMID: 28664931 PMCID: PMC7542347 DOI: 10.1038/nrurol.2017.76] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and - typically - fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Charlton Bldg/Desk R - SL, Rochester, Minnesota 5590, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St BWH. Radiation Oncology, Boston, Massachusetts 02115, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, 1240 Lee St, Charlottesville, Virginia 22908, USA
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Gerard C Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
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12
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13
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Analysis of Global Radiotherapy Needs and Costs by Geographic Region and Income Level. Clin Oncol (R Coll Radiol) 2017; 29:84-92. [DOI: 10.1016/j.clon.2016.11.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/21/2022]
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14
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Avkshtol V, Dong Y, Hayes SB, Hallman MA, Price RA, Sobczak ML, Horwitz EM, Zaorsky NG. A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer. Res Rep Urol 2016; 8:145-58. [PMID: 27574585 PMCID: PMC4993397 DOI: 10.2147/rru.s58262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer is the most prevalent cancer diagnosed in men in the United States besides skin cancer. Stereotactic body radiation therapy (SBRT; 6–15 Gy per fraction, up to 45 minutes per fraction, delivered in five fractions or less, over the course of approximately 2 weeks) is emerging as a popular treatment option for prostate cancer. The American Society for Radiation Oncology now recognizes SBRT for select low- and intermediate-risk prostate cancer patients. SBRT grew from the notion that high doses of radiation typical of brachytherapy could be delivered noninvasively using modern external-beam radiation therapy planning and delivery methods. SBRT is most commonly delivered using either a traditional gantry-mounted linear accelerator or a robotic arm-mounted linear accelerator. In this systematic review article, we compare and contrast the current clinical evidence supporting a gantry vs robotic arm SBRT for prostate cancer. The data for SBRT show encouraging and comparable results in terms of freedom from biochemical failure (>90% for low and intermediate risk at 5–7 years) and acute and late toxicity (<6% grade 3–4 late toxicities). Other outcomes (eg, overall and cancer-specific mortality) cannot be compared, given the indolent course of low-risk prostate cancer. At this time, neither SBRT device is recommended over the other for all patients; however, gantry-based SBRT machines have the abilities of treating larger volumes with conventional fractionation, shorter treatment time per fraction (~15 minutes for gantry vs ~45 minutes for robotic arm), and the ability to achieve better plans among obese patients (since they are able to use energies >6 MV). Finally, SBRT (particularly on a gantry) may also be more cost-effective than conventionally fractionated external-beam radiation therapy. Randomized controlled trials of SBRT using both technologies are underway.
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Affiliation(s)
- Vladimir Avkshtol
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Yanqun Dong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Shelly B Hayes
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mark L Sobczak
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Rodríguez A, Borrás JM, López-Torrecilla J, Algara M, Palacios-Eito A, Gómez-Caamaño A, Olay L, Lara PC. Demand for radiotherapy in Spain. Clin Transl Oncol 2016; 19:204-210. [PMID: 27492014 DOI: 10.1007/s12094-016-1525-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/10/2016] [Indexed: 01/05/2023]
Abstract
AIM Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. MATERIAL AND METHODS We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. RESULTS About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. CONCLUSIONS Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning.
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Affiliation(s)
- A Rodríguez
- Department of Radiation Oncology, Hospital Ruber Internacional, C/La Masó 38, 28034, Madrid, Spain.
| | - J M Borrás
- Universidad de Barcelona, IDIBELL, Gran Vía de L'Hospitalet 199, Hospitalet del Llobregat, 08908, Barcelona, Spain
| | - J López-Torrecilla
- Department of Radiation Oncology, ERESA Hospital General Universitario, Calle de la Casa Misericordia 12, 46014, Valencia, Spain
| | - M Algara
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona, Spain
- Universitat Pompeu Fabra, San José de la Montaña 12, 08024, Barcelona, Spain
| | - A Palacios-Eito
- Department of Radiation Oncology, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - A Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Travesia de Choupana s/n, 15706, Santiago de Compostela, La Coruña, Spain
| | - L Olay
- Department of Radiation Oncology, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain
| | - P C Lara
- Department of Radiation Oncology, Hospital Universitario Dr Negrín, Barranco de la Ballena s/n, 35010, Las Palmas, Spain
- Clinical Oncology, Universidad de Las Palmas, Las Palmas, Spain
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16
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Zaorsky NG, Horwitz EM. Brachytherapy for Prostate Cancer: An Overview. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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17
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Mineikytė R, Janulionis E, Atkočius V, Jaruševičius L, Plieskienė A, Gečas J. The changes of radiotherapy in Lithuania: infrastructure, utilization rate, and cost. Acta Med Litu 2016; 23:17-23. [PMID: 28356788 PMCID: PMC4924636 DOI: 10.6001/actamedica.v23i1.3266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/21/2016] [Indexed: 11/27/2022] Open
Abstract
Background. The aim of this study was to evaluate radiation therapy (RT) productivity, capacity, and cost in Lithuania. Materials and methods. An electronic questionnaire was prepared and sent to the country's RT centres. The data was collected for the years 2011-2014. The early data of the RT infrastructure was obtained from the QUARTS Project (2001). Results. In Lithuania the external beam RT was applied to 32.6% of new cancer cases (non-melanomatous skin cancer and benign conditions were excluded). In 2014, RT was more frequently applied for breast and prostate carcinomas, 23 and 20%, respectively. The country owned 11 units of linear accelerators (linacs) and this accounts for 3.7 linacs per one million population. 3D conformal RT is the standard approach in all four RT centres in Lithuania. IMRT practices were established in three centers and VMAT or stereotactic RT in two of them. 73% of linacs were capable of IGRT, while only 27% were equipped with CBCT. The average linac workload was 567 patients per year and showed a 10% decrease compared with the 2011 data. During a ten-year period, the average cost per patient for RT treatment increased 7.6 times - from EUR 129 to 974. The reimbursement system in Lithuania is not favourable for application of RT. Conclusions. During the recent thirteen years, RT services in Lithuania have dramatically improved, but we are still behind the average of European countries and benchmark rates. It is important to continue optimising the efficiency of RT services, and further evidence-based studies on RT infrastructure assessment and planning are needed.
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Affiliation(s)
| | | | | | - Laimonas Jaruševičius
- The Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | | | - Jonas Gečas
- Republican Šiauliai Hospital, Šiauliai, Lithuania
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18
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Lievens Y, Borras JM, Grau C. Cost calculation: a necessary step towards widespread adoption of advanced radiotherapy technology. Acta Oncol 2015. [PMID: 26198650 DOI: 10.3109/0284186x.2015.1066932] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Radiotherapy costs are an often underestimated component of the economic assessment of new radiotherapy treatments and technologies. That the radiotherapy budget only consumes a finite part of the total cancer and healthcare budget does not relieve us from our responsibility to balance the extra costs to the additional benefits of new, more advanced, but typically also more expensive treatments we want to deliver. Yet, in contrast to what is the case for oncology drugs, literature evidence remains limited, as well for economic evaluations comparing new radiotherapy interventions as for cost calculation studies. Even more cumbersome, the available costing studies in the field of radiotherapy fail to accurately capture the real costs of our treatments due to the large variation in cost inputs, in scope of the analysis, in costing methodology. And this is not trivial. Accurate resource cost accounting lays the basis for the further steps in health technology assessment leading to radiotherapy investments and reimbursement, at the local, the national and the worldwide level. In the current paper we review some evidence from the existing costing literature and discuss how such data can be used to support reimbursement setting and investment cases for new radiotherapy equipment and infrastructure.
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Affiliation(s)
- Yolande Lievens
- a Radiation Oncology Department, Ghent University Hospital , Ghent , Belgium
| | | | - Cai Grau
- c Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
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19
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Sundaresan P, King MT, Stockler MR, Costa DS, Milross CG. Barriers to radiotherapy utilisation in New South Wales Australia: Health professionals' perceptions of impacting factors. J Med Imaging Radiat Oncol 2015; 59:535-541. [PMID: 26076378 DOI: 10.1111/1754-9485.12334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/11/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Utilisation of radiation therapy (RT) in Australia is below recommended evidence-based benchmarks. Barriers to the referral of patients for RT and the uptake of RT by patients may be affecting RT utilisation. The current study aimed to examine health professionals' (HPs) perceptions of potential barriers to RT referral and uptake. METHODS A custom survey was developed to assess perceptions regarding the degree to which a range of issues affect decisions regarding RT. Hard copy surveys were disseminated to HPs involved in the care of cancer patients across New South Wales (NSW): medical, radiation and surgical oncologists, physicians (including palliative care), and general practitioners with an interest in oncology. Electronic versions of the survey were disseminated via oncology multidisciplinary teams and professional networks at participating hospitals. RESULTS Two hundred fifty-three HPs participated via hard copy (n = 208) or electronic (n = 45) surveys. Two-thirds of HPs perceived acute side effects of RT, their management and impact on daily commitments, as well as fear and anxiety about RT, to exert moderate to significant influence on RT decisions. Treatment-related travel, need for accommodation and relocation were also perceived by 64% of HPs to do the same. Over half of HPs rated concern regarding late effects of RT, disruption to family and work life, and the ability to organise family and work commitments around RT, as moderate to significant influences on RT uptake. CONCLUSION Perceptions of HPs in NSW reveal potential important influencers of RT decisions by patients and clinicians. An understanding of these additional issues and their actual impact on RT-related decisions may inform future interventions to improve RT access and utilisation.
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Affiliation(s)
- Puma Sundaresan
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Madeleine T King
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group (PoCoG), University of Sydney, Sydney, New South Wales, Australia
| | - Martin R Stockler
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Clinical Trials Centre, National Health and Medical Research Centre, Sydney, New South Wales, Australia
| | - Daniel Sj Costa
- Psycho-Oncology Cooperative Research Group (PoCoG), University of Sydney, Sydney, New South Wales, Australia
| | - Christopher G Milross
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Chris O'Brien Life House, Sydney, New South Wales, Australia
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20
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Hanly P, Céilleachair AÓ, Skally M, O'Neill C, Sharp L. Direct costs of radiotherapy for rectal cancer: a microcosting study. BMC Health Serv Res 2015; 15:184. [PMID: 25934169 PMCID: PMC4494796 DOI: 10.1186/s12913-015-0845-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background Radiotherapy provides significant benefits in terms of reducing risk of local recurrence and death from rectal cancer. Despite this, up-to-date cost estimates for radiotherapy are lacking, potentially inhibiting policy and decision-making. Our objective was to generate an up-to-date estimate of the cost of traditional radiotherapy for rectal cancer and model the impact of a range of potential efficiency improvements. Methods Microcosting methods were used to estimate total direct radiotherapy costs for long- (assumed at 45-50 Gy in 25 daily fractions over a 5 week period) and short-courses (assumed at 25 Gy in 5 daily fractions over a one week period). Following interviews and on-site visits to radiotherapy departments in two designated cancer centers, a radiotherapy care pathway for a typical rectal cancer patient was developed. Total direct costs were derived by applying fixed and variable unit costs to resource use within each care phase. Costs included labor, capital, consumables and overheads. Sensitivity analyses were performed. Results Radiotherapy treatment was estimated to cost between €2,080 (5-fraction course) and €3,609 (25-fraction course) for an average patient in 2012. Costs were highest in the treatment planning phase for the short-course (€1,217; 58% of total costs), but highest in the radiation treatment phase for the long-course (€1,974: 60% of total costs). By simultaneously varying treatment time, capacity utilization rates and linear accelerator staff numbers, the base cost fell by 20% for 5-fractions: (€1,660) and 35% for 25-fractions: (€2,354). Conclusions Traditional radiotherapy for rectal cancer is relatively inexpensive. Moreover, significant savings may be achievable through service organization and provision changes. These results suggest that a strong economic argument can be made for expanding the use of radiotherapy in rectal cancer treatment.
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Affiliation(s)
- Paul Hanly
- School of Business, National College of Ireland, Dublin, Ireland.
| | | | - Máiréad Skally
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
| | - Ciaran O'Neill
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Linda Sharp
- Research Department, National Cancer Registry Ireland, Cork, Ireland.
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21
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Zaorsky NG, Hurwitz MD, Dicker AP, Showalter TN, Den RB. Is robotic arm stereotactic body radiation therapy “virtual high dose ratebrachytherapy” for prostate cancer? An analysis of comparative effectiveness using published data [corrected]. Expert Rev Med Devices 2014; 12:317-27. [PMID: 25540018 DOI: 10.1586/17434440.2015.994606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
High-dose rate brachytherapy (HDR-BT) monotherapy and robotic arm (i.e., CyberKnife) stereotactic body radiation therapy (SBRT) are emerging technologies that have become popular treatment options for prostate cancer. Proponents of both HDR-BT monotherapy and robotic arm SBRT claim that these modalities are as efficacious as intensity-modulated radiation therapy in treating prostate cancer. Moreover, proponents of robotic arm SBRT believe it is more effective than HDR-BT monotherapy because SBRT is non-invasive, touting it as 'virtual HDR-BT.' We perform a comparative effective analysis of the two technologies. The tumor control rates and toxicities of HDR-BT monotherapy and robotic arm SBRT are promising. However, at present, it would be inappropriate to state that HDR-BT monotherapy and robotic arm SBRT are as efficacious or effective as other treatment modalities for prostate cancer, which have stronger foundations of evidence. Studies reporting on these technologies have relatively short follow-up time, few patients and are largely retrospective.
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22
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Adamson D, Blazeby J, Nelson A, Hurt C, Nixon L, Fitzgibbon J, Crosby T, Staffurth J, Evans M, Kelly NH, Cohen D, Griffiths G, Byrne A. Palliative radiotherapy in addition to self-expanding metal stent for improving dysphagia and survival in advanced oesophageal cancer (ROCS: Radiotherapy after Oesophageal Cancer Stenting): study protocol for a randomized controlled trial. Trials 2014; 15:402. [PMID: 25336193 PMCID: PMC4223756 DOI: 10.1186/1745-6215-15-402] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/01/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The single most distressing symptom for patients with advanced esophageal cancer is dysphagia. Amongst the more effective treatments for relief of dysphagia is insertion of a self-expanding metal stent (SEMS). It is possible that the addition of a palliative dose of external beam radiotherapy may prolong the relief of dysphagia and provide additional survival benefit. The ROCS trial will assess the effect of adding palliative radiotherapy after esophageal stent insertion. METHODS/DESIGN The study is a randomized multicenter phase III trial, with an internal pilot phase, comparing stent alone versus stent plus palliative radiotherapy in patients with incurable esophageal cancer. Eligible participants are those with advanced esophageal cancer who are in need of stent insertion for primary management of dysphagia. Radiotherapy will be administered as 20 Gray (Gy) in five fractions over one week or 30 Gy in 10 fractions over two weeks, within four weeks of stent insertion. The internal pilot will assess rates and methods of recruitment; pre-agreed criteria will determine progression to the main trial. In total, 496 patients will be randomized in a 1:1 ratio with follow up until death. The primary outcome is time to progression of patient-reported dysphagia. Secondary outcomes include survival, toxicity, health resource utilization, and quality of life. An embedded qualitative study will explore the feasibility of patient recruitment by examining patients' motivations for involvement and their experiences of consent and recruitment, including reasons for not consenting. It will also explore patients' experiences of each trial arm. DISCUSSION The ROCS study will be a challenging trial studying palliation in patients with a poor prognosis. The internal pilot design will optimize methods for recruitment and data collection to ensure that the main trial is completed on time. As a pragmatic trial, study strengths include collection of all follow-up data in the usual place of care, and a focus on patient-reported, rather than disease-orientated, outcomes. Exploration of patient experience and health economic analyses will be integral to the assessment of benefit for patients and the NHS. TRIAL REGISTRATION The trial was registered with Current Controlled Trials (registration number: ISRCTN12376468) on 10 July 2012.
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Affiliation(s)
- Douglas Adamson
- />Tayside Cancer Centre, Ward 32, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Jane Blazeby
- />School of Social & Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Annmarie Nelson
- />Marie Curie Palliative Care Research Centre, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 1st Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Chris Hurt
- />Wales Cancer Trials Unit, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Lisette Nixon
- />Wales Cancer Trials Unit, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Jim Fitzgibbon
- />Wales Cancer Trials Unit, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Tom Crosby
- />Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, CF14 2TL UK
| | - John Staffurth
- />Institute of Cancer and Genetics, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XW UK
| | - Mim Evans
- />National Institute for Social Care and Health Research (NISCHR), Clinical Research Centre, 3rd Floor 12 Cathedral Road, Cardiff, CF11 9LJ UK
| | - Noreen Hopewell Kelly
- />Marie Curie Palliative Care Research Centre, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 1st Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - David Cohen
- />NISCHR Welsh Health Economics Support Service, University of South Wales, Pontypridd, CF37 1DL UK
| | - Gareth Griffiths
- />University of Southampton Clinical Trials Unit, MP 131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
| | - Anthony Byrne
- />Marie Curie Palliative Care Research Centre, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 1st Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
- />Wales Cancer Trials Unit, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
- />Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, CF14 2TL UK
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Zaorsky NG, Doyle LA, Hurwitz MD, Dicker AP, Den RB. Do theoretical potential and advanced technology justify the use of high-dose rate brachytherapy as monotherapy for prostate cancer? Expert Rev Anticancer Ther 2014; 14:39-50. [PMID: 24124755 DOI: 10.1586/14737140.2013.836303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Low-dose rate brachytherapy (LDR-BT), involving implantation of radioactive seeds into the prostate, is an established monotherapy for most low-risk and select intermediate- and high-risk prostate cancer patients. High-dose rate brachytherapy (HDR-BT) is an advanced technology theorized to be more advantageous than LDR-BT from a radiobiological and radiophysics perspective, to the patient himself, and in terms of resource allocation. Studies of HDR-BT monotherapy have encouraging results in terms of biochemical control, patient survival, treatment toxicity and erectile preservation. However, there are still certain limitations that preclude recommending HDR-BT monotherapy for prostate cancer outside the setting of a clinical trial. HDR-BT monotherapy should be considered experimental at present.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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24
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Sundaresan P, Milross CG, Smith A, Evans A, Stockler MR, King MT. Factors influencing the use of RT in NSW: a qualitative study exploring consumer and health professional perspectives. J Med Imaging Radiat Oncol 2014; 58:625-32. [PMID: 24945988 DOI: 10.1111/1754-9485.12198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/24/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radiotherapy (RT) is an essential and cost-effective cancer treatment. It is underutilised in Australia. Bridging the gap between actual and optimal RT utilisation requires not only provision of adequate RT infrastructure but also an understanding of the factors that influence the extent to which this opportunity for RT is utilised. This study explored factors perceived to affect RT-related decision making by consumers and health professionals (HPs). METHODS Six semi-structured focus groups (FGs) and 13 interviews were conducted at three geographical locations in NSW, Australia (n = 26 consumers and 30 HPs). Audio recordings of FGs and interviews were transcribed verbatim and analysed thematically. RESULTS An exhaustive list of issues perceived to affect consumer and HP RT decisions was identified. There were common themes across participant groups and locations. Perceptions of RT and its benefits, as well as accurate communication of the expected benefits and risks of RT, were highlighted as important to decision making. Perceived factors relating to 'inconvenience' of RT were multifaceted and included travel, relocation, accommodation, time away from work and financial challenges. Perceived potential barriers to RT referral included knowledge of RT and RT services, availability of a local or visiting RT service, referrer bias, and the low profile of RT. CONCLUSIONS Important drivers during RT decisions appear to include the perceived benefit, risks and inconvenience of RT. Underutilisation of RT may also result from multiple barriers at the referrer level. Further research into whether these factors influence actual RT decisions is needed.
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Affiliation(s)
- Puma Sundaresan
- The Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Central Coast Cancer Centre, Gosford Hospital, Sydney, New South Wales, Australia
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Vanderstraeten B, Verstraete J, De Croock R, De Neve W, Lievens Y. In search of the economic sustainability of Hadron therapy: the real cost of setting up and operating a Hadron facility. Int J Radiat Oncol Biol Phys 2014; 89:152-60. [PMID: 24725698 DOI: 10.1016/j.ijrobp.2014.01.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/06/2014] [Accepted: 01/23/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the treatment cost and required reimbursement for a new hadron therapy facility, considering different technical solutions and financing methods. METHODS AND MATERIALS The 3 technical solutions analyzed are a carbon only (COC), proton only (POC), and combined (CC) center, each operating 2 treatment rooms and assumed to function at full capacity. A business model defines the required reimbursement and analyzes the financial implications of setting up a facility over time; activity-based costing (ABC) calculates the treatment costs per type of patient for a center in a steady state of operation. Both models compare a private, full-cost approach with public sponsoring, only taking into account operational costs. RESULTS Yearly operational costs range between €10.0M (M = million) for a publicly sponsored POC to €24.8M for a CC with private financing. Disregarding inflation, the average treatment cost calculated with ABC (COC: €29,450; POC: €46,342; CC: €46,443 for private financing; respectively €16,059, €28,296, and €23,956 for public sponsoring) is slightly lower than the required reimbursement based on the business model (between €51,200 in a privately funded POC and €18,400 in COC with public sponsoring). Reimbursement for privately financed centers is very sensitive to a delay in commissioning and to the interest rate. Higher throughput and hypofractionation have a positive impact on the treatment costs. CONCLUSIONS Both calculation methods are valid and complementary. The financially most attractive option of a publicly sponsored COC should be balanced to the clinical necessities and the sociopolitical context.
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Affiliation(s)
| | - Jan Verstraete
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, Gent, Belgium
| | - Yolande Lievens
- Department of Radiotherapy, Ghent University Hospital, Gent, Belgium
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Adamietz IA, Micke O, Popp W, Sack H. Evaluating the attendance of medical staff and room occupancy during palliative radiotherapy. Strahlenther Onkol 2014; 190:781-5. [PMID: 24820198 DOI: 10.1007/s00066-014-0671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Attendance of staff and use of resources during treatment have an impact on costs. For palliative radiotherapy, no reliable data are available on the subject. Therefore, the measurement of selected variables (staff absorbance and room occupancy) based on daily palliative irradiation was the aim of our prospective study. The analysis is part of a larger study conducted by the German Society of Radiation Oncology (DEGRO). PATIENTS, MATERIAL, AND METHODS A total of 172 palliative radiation treatments were followed up prospectively between October 2009 and March 2010. The study was performed at two experienced radiotherapy departments (Herne and Bielefeld) and evaluated the attendance of medical personnel and room occupancy related to the selected steps of the treatment procedure: treatment planning and daily application of radiation dose. RESULTS Computed tomography for treatment planning engaged the unit for 19 min (range: 17-22 min). The localization of target volume required on average 28 min of a technician's working time. The mean attendance of the entire staff (radiation oncologist, physicist, technician) for treatment planning was 159 min, while the total room occupancy was 140 min. Depending on the type of treatment, the overall duration of a radiotherapy session varied on average between 8 and 18 min. The staff was absorbed by the first treatment session (including portal imaging) for 8-27 min. Mean room occupancy was 18 min (range: 6-65 min). The longest medical staff attendance was observed during an initial irradiation session (mean: 11 min). Radiotherapy sessions with weekly performed field verifications occupied the rooms slightly longer (mean: 10 min, range: 4-25 min) than daily radiotherapy sessions (mean: 9 min, range: 3-29 min). We observed that the patients' symptoms, their condition, and their social environment confounded the time schedule. CONCLUSIONS Target localization, treatment planning, and performance of palliative radiotherapy absorb resources to an extent comparable to nonpalliative treatment. Because of unexpected events, the time schedule before and during radiotherapy may reveal strong interindividual variability.
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Affiliation(s)
- Irenäus A Adamietz
- Department of Radiation Oncology, University of Bochum, Bochum, Germany,
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Matias LDS, Lind BK, Maphossa AM, Gudowska I, Toma-Dasu I. Cancer incidence and radiation therapy in Mozambique - a comparative study to Sweden. Acta Oncol 2014; 53:712-5. [PMID: 24286538 DOI: 10.3109/0284186x.2013.861078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lucílio Dos S Matias
- Medical Radiation Physics, Stockholm University and Karolinska Institutet , Sweden
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High dose rate brachytherapy boost for prostate cancer: A systematic review. Cancer Treat Rev 2014; 40:414-25. [DOI: 10.1016/j.ctrv.2013.10.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/10/2013] [Accepted: 10/16/2013] [Indexed: 11/22/2022]
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Vorwerk H, Zink K, Schiller R, Budach V, Böhmer D, Kampfer S, Popp W, Sack H, Engenhart-Cabillic R. Protection of quality and innovation in radiation oncology: The prospective multicenter trial the German Society of Radiation Oncology (DEGRO-QUIRO study). Strahlenther Onkol 2014; 190:433-43. [DOI: 10.1007/s00066-014-0634-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
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Camacho R, Neves D, Piñeros M, Rosenblatt E, Burton R, Galán Y, Hawari F, Kilickap S, Naylor C, Nicula F, Reno J, Sirohi B, Vidaurre T, Zendehdel K. Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jct.2014.511103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zaorsky NG, Harrison AS, Trabulsi EJ, Gomella LG, Showalter TN, Hurwitz MD, Dicker AP, Den RB. Evolution of advanced technologies in prostate cancer radiotherapy. Nat Rev Urol 2013; 10:565-79. [DOI: 10.1038/nrurol.2013.185] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zaorsky NG, Ohri N, Showalter TN, Dicker AP, Den RB. Systematic review of hypofractionated radiation therapy for prostate cancer. Cancer Treat Rev 2013; 39:728-36. [PMID: 23453861 DOI: 10.1016/j.ctrv.2013.01.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 01/11/2023]
Abstract
Prostate cancer is the second most prevalent solid tumor diagnosed in men in the United States and Western Europe. Conventionally fractionated external beam radiation therapy (1.8-2.0 Gy/fraction) is an established treatment modality for men in all disease risk groups. Emerging evidence from experimental and clinical studies suggests that the α/β ratio for prostate cancer may be as low as 1.5 Gy, which has prompted investigators around the world to explore moderately hypofractionated radiation therapy (2.1-3.5 Gy/fraction). We review the impetus behind moderate hypofractionation and the current clinical evidence supporting moderate hypofractionated radiation therapy for prostate cancer. Although hypofractionated radiation therapy has many theoretical advantages, there is no clear evidence from prospective, randomized, controlled trials showing that hypofractionated schedules have improved outcomes or lower toxicity than conventionally fractionated regimens. Currently, hypofractionated schedules should only be used in the context of clinical trials. High dose rate brachytherapy and stereotactic body radiation therapy (fraction size 3.5 Gy and greater) are alternative approaches to hypofractionation, but are beyond the scope of this report.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Jefferson Medical College & Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Leung HWC, Chan ALF. Direct medical cost of radiation therapy for cancer patients in Taiwan. Health (London) 2013. [DOI: 10.4236/health.2013.56131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zaorsky NG, Studenski MT, Dicker AP, Gomella L, Den RB. Stereotactic body radiation therapy for prostate cancer: is the technology ready to be the standard of care? Cancer Treat Rev 2012; 39:212-8. [PMID: 23218442 DOI: 10.1016/j.ctrv.2012.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/19/2012] [Accepted: 10/22/2012] [Indexed: 11/17/2022]
Abstract
Prostate cancer is the second most prevalent solid tumor diagnosed in men in the United States and Western Europe. Stereotactic body radiation therapy (SBRT) is touted as a superior type of external beam radiation therapy (EBRT) for the treatment of various tumors. SBRT developed from the theory that high doses of radiation from brachytherapy implant seeds could be recapitulated from advanced technology of radiation treatment planning and delivery. Moreover, SBRT has been theorized to be advantageous compared to other RT techniques because it has a treatment course shorter than that of conventionally fractionated EBRT (a single session, five days per week, for about two weeks vs. eight weeks), is non-invasive, is more effective at killing tumor cells, and is less likely to cause damage to normal tissue. In areas of the US and Europe where there is limited access to RT centers, SBRT is frequently being used to treat prostate cancer, even though long-term data about its efficacy and safety are not well established. We review the impetus behind SBRT and the current clinical evidence supporting its use for prostate cancer, thus providing oncologists and primary care physicians with an understanding of the continually evolving field of prostate radiation therapy. Studies of SBRT provide encouraging results of biochemical control and late toxicity. However, they are limited by a number of factors, including short follow-up, exclusion of intermediate- and high-risk patients, and relatively small number of patients treated. Currently, SBRT regimens should only be used in the context of clinical trials.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Blank E, Willich N, Fietkau R, Popp W, Schaller-Steiner J, Sack H, Wenz F. Evaluation of time, attendance of medical staff, and resources during radiotherapy for breast cancer patients. The DEGRO-QUIRO trial. Strahlenther Onkol 2012; 188:113-9. [PMID: 22241435 DOI: 10.1007/s00066-011-0020-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/10/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND PURPOSE To conform to recommendations regarding the treatment of breast cancer, an estimation of costs and personnel to assure treatment is required. To date no recommendations based on real time measurements are available. The DEGRO (German Society of Radiation Oncology), therefore, initiated a prospective multicenter evaluation of core procedures of radiotherapy. In this analysis, the results regarding human resources and room occupation during the treatment of breast cancer are presented. PATIENTS AND METHODS Three academic radiation oncology centers (Erlangen, Münster, Mannheim) prospectively documented their workflow and working time for all breast cancer patients from July-October 2008. Subsequently, a statistical analysis was performed. RESULTS The longest working time of physicians was the definition of the target volume and organs at risk (mean 33 min). Furthermore, physicians needed much time for general tasks, which included conversations. Physicists needed the most time for treatment planning and authorization (64 min), whereas technicians were mostly needed in day-to-day radiotherapy treatment (15 min, 31 min including verification). Despite significant differences in specific steps between centers, overall working times and room occupation were comparable and representative. Special procedures (intraoperative radiotherapy/multicatheter brachytherapy) required considerable amounts of additional working time of physicians and physicists. CONCLUSION In this prospective analysis, data of human resources and room occupation during treatment of breast cancer are presented for the first time. Each patient consumes about 12 h of human resources for treatment and 3.75 h for general tasks (physicians 4.7 h, physicists 1.8 h, and technicians 9.2 h).
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Affiliation(s)
- E Blank
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
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The cost of radiotherapy in a decade of technology evolution. Radiother Oncol 2011; 102:148-53. [PMID: 21872955 DOI: 10.1016/j.radonc.2011.07.033] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 07/20/2011] [Accepted: 07/21/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE To quantify changes in radiotherapy costs occurring in a decade of medical-technological evolution. MATERIALS AND METHODS The activity-based costing (ABC) model of the University Hospitals Leuven (UHL) radiotherapy (RT) department was adapted to current RT standards. It allocated actual resource costs to the treatments based on the departmental work-flow and patient mix in 2009. A benchmark with the former model analyzed the cost increases related to changes in RT infrastructure and practice over 10 years. RESULTS A considerable increase in total RT costs was observed, resulting from higher capital investments (96%) and personnel cost (103%), the latter dominating the total picture. Treatment delivery remains the most costly activity, boosted by the cost of improved quality assurance (QA), 23% of total product costs, coming along with more advanced RT techniques. Hence, cost increases at the product level are most obvious for complex treatments, such as intensity-modulated radiotherapy (IMRT), representing cost increases ranging between 38% and 88% compared to conformal approaches. CONCLUSIONS The ABC model provides insight into the financial consequences of evolving technology and practice. Such data are a mandatory first step in our strive to prove RT cost-effectiveness and thus support optimal reimbursement and provision of radiotherapy departments.
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Budach W, Bölke E, Fietkau R, Buchali A, Wendt TG, Popp W, Matuschek C, Sack H. Evaluation of Time, Attendance of Medical Staff, and Resources During Radiotherapy for Head and Neck Cancer Patients. Strahlenther Onkol 2011; 187:449-60. [DOI: 10.1007/s00066-011-2273-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 05/16/2011] [Indexed: 11/29/2022]
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Morgan GW, Barton M, Atkinson C, Millar J, Kumar Gogna N, Yeoh E. 'GAP' in radiotherapy services in Australia and New Zealand in 2009. J Med Imaging Radiat Oncol 2010; 54:287-97. [PMID: 20598017 DOI: 10.1111/j.1754-9485.2010.02172.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM In this study we estimated (a) the number of linear accelerators required in Australia and New Zealand to achieve a 52.3% treatment rate; (b) the 'GAP' between the actual and required number of linear accelerators; c) the number of persons not treated (PNT), premature deaths (PD) and years of life lost (YLL) as a result of the 'GAP'; and (d) to review the actions being taken by health jurisdictions in Australia and in New Zealand to address the 'GAP' and reach the 52.3% treatment rate. MATERIAL AND METHODS The actual number of fully staffed and operating linear accelerators (A) in Australian and New Zealand was obtained from a survey of radiotherapy facilities in December 2009. The required number of linear accelerators (R) was calculated from the projected cancer incidence figures for 2009 and was based on 1.6 linear accelerators being required per 1000 new cancer patients. The 'GAP' in Radiotherapy services (G) was R minus A. The maximum treatment capacity (MTC) was the ratio of A over R multiplied by 52.3%, assuming that all linear accelerators were operating at 100% capacity. As each linear accelerator can treat 331 new patients each year, the number of new cancer PNT is G x 331. The estimated 5-year survival benefit from radiotherapy is 16%, and the average survival for all patients receiving radiotherapy (radical and palliative) is 0.76 year. Hence, the number of PD attributed to the 'GAP' is PNT x 16%, and the YLL to cancer is PNT x 0.76. A literature search and local knowledge of health department Radiotherapy Plans in all jurisdictions were used to determine the action being taken to achieve a 52.3% treatment rate. RESULTS In 2009, the 'GAP' was 50 linear accelerators in Australia and the MTC was 38%, the same as it was in 1999, but there has been an increase in PNT each year from 7419 in 1999 to 16,550 in 2009, and PD each year increased from 1187 in 1999 to 2649 in 2009, and YLL each year increased from 5638 in 1999 to 12,585 in 2009. In New Zealand in 2009, the 'GAP' was nine linear accelerators and the MTC was 38%. An estimated 3310 persons did not receive radiotherapy in 2009 in New Zealand, and as a result, there were 523 PD and 2266 YLL. The review showed that new and replacement machines were being installed in all jurisdictions in Australia and in New Zealand. Only Victoria and Queensland have a Radiotherapy Plan beyond 2010, but both have underestimated the projected cancer incidence. CONCLUSION Urgent action is needed by health departments and governments on both sides of the Tasman to improve access and equity to this essential cancer treatment. There is merit in the Baume Report recommendation of establishing a national body to oversee radiotherapy services in all jurisdictions in Australia. A similar central body should also be considered for New Zealand.
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Affiliation(s)
- G W Morgan
- Northern Sydney Cancer Centre, Department of Radiation Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.
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Williams M, Cooper T, Mackay R, Staffurth J, Routsis D, Burnet N. The Implementation of Intensity-modulated Radiotherapy in the UK. Clin Oncol (R Coll Radiol) 2010; 22:623-8. [DOI: 10.1016/j.clon.2010.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 04/08/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
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Abstract
A large amount of clinical evidence has recently accumulated supporting the efficacy and safety of hypofractionated radiotherapy for post-operative breast cancer. These schedules, typically delivering a lower total dose in fewer, but larger than 2 Gy fractions, are more convenient for the patients by limiting the number of treatment attendances. Moreover, the reduced resource use in terms of personnel and machine time is advantageous for radiotherapy departments and translates into lower treatment costs. In order to formally validate this therapeutic approach from a societal perspective, however, cost-effectiveness evaluations weighing long-term outcome against the societal costs incurred until many years after treatment are needed.
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Affiliation(s)
- Yolande Lievens
- Department of Radiation Oncology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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Thwaites DI, Verellen D. Vorsprung durch Technik: evolution, implementation, QA and safety of new technology in radiotherapy. Radiother Oncol 2010; 94:125-8. [PMID: 20170973 DOI: 10.1016/j.radonc.2010.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 11/18/2022]
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Van de Werf E, Lievens Y, Verstraete J, Pauwels K, Van den Bogaert W. Time and motion study of radiotherapy delivery: Economic burden of increased quality assurance and IMRT. Radiother Oncol 2009; 93:137-40. [DOI: 10.1016/j.radonc.2009.07.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 07/08/2009] [Accepted: 07/18/2009] [Indexed: 12/21/2022]
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Glimelius B, Ask A, Bjelkengren G, Björk-Eriksson T, Blomquist E, Johansson B, Karlsson M, Zackrisson B. Number of patients potentially eligible for proton therapy. Acta Oncol 2009; 44:836-49. [PMID: 16332591 DOI: 10.1080/02841860500361049] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A group of Swedish radiation oncologists and hospital physicists have estimated the number of patients in Sweden suitable for proton beam therapy in a facility where one of the principal aims is to facilitate randomized and other studies in which the advantage of protons can be shown and the magnitude of the differences compared with optimally administered conventional radiation treatment, also including intensity-modulated radiation therapy (IMRT) and brachytherapy, can be shown. The estimations have been based on current statistics of tumour incidence in Sweden, number of patients potentially eligible for radiation treatment, scientific support from clinical trials and model dose planning studies and knowledge of the dose-response relations of different tumours together with information on normal tissue complication rates. In Sweden, it is assessed that between 2200 and 2500 patients annually are eligible for proton beam therapy, and that for these patients the potential therapeutic benefit is so great as to justify the additional expense of proton therapy. This constitutes between 14-15% of all irradiated patients annually.
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Affiliation(s)
- Bengt Glimelius
- Department of Oncology, Radiology and Clinical Immunology, Karolinska Institutet, Akademiska sjukhuset, Uppsala, Stockholm, Sweden.
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Burmeister BH, Zarate DD, Burmeister EA, Harden HE, Colquist SP, Cossio DL, Poulsen MG, Collins M, Pratt GR, Walpole ET. Lung cancer patients in Queensland suffer delays in receiving radiation therapy--but not as a result of distance. Intern Med J 2009; 40:126-32. [PMID: 19220556 DOI: 10.1111/j.1445-5994.2009.01912.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To determine whether lung cancer radiation therapy waiting times in Queensland public hospitals are associated with distance of residence from the nearest treatment facility. METHODS Retrospective analysis of radiation therapy waiting times of 1535 Queensland residents who were diagnosed with lung cancer from 2000 to 2004 and received radiation therapy as initial treatment at a public hospital. The effect of distance of residence from treatment centre on median waiting time was analysed by quantile regression controlling for sex, age, lung cancer histology, stage and therapeutic intent. RESULTS The median waiting time from diagnosis to start of radiation therapy was 33 days for all patients. There was no significant difference (P = 0.141) in median waiting times in relation to distance of residence from a treatment centre. However, in most patients, waiting times were significantly longer than recommended by the Royal Australian and New Zealand College of Radiologists. Curative patients waited longer than palliative patients, while patients with earlier stage cancer waited longer than those with more advanced disease. CONCLUSION Waiting times for radiation therapy among lung cancer patients in Queensland was not associated with distance from place of residence to the nearest public treatment facility. However, delays overall are excessive and are likely to worsen unless radiation treatment capabilities are enhanced to keep pace with population growth in Queensland.
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Affiliation(s)
- B H Burmeister
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
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Radiotherapy for lung cancer: clinical impact of recent technical advances. Lung Cancer 2008; 64:1-8. [PMID: 18771814 DOI: 10.1016/j.lungcan.2008.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/07/2008] [Accepted: 07/21/2008] [Indexed: 12/25/2022]
Abstract
Radiation oncology plays an important role in the curative treatment of patients with lung cancer. New technological developments have enabled delivery of higher radiation doses while better sparing surrounding normal tissues, thereby increasing the likelihood of local control without increased toxicity. Multi-modality imaging enables better target definition, improved planning software allows for correct calculation of delivered doses, and tools to verify accurate treatment delivery are now available. A good example of the results of applying these developments is the high local control rates achieved in stage I NSCLC with stereotactic radiotherapy (SRT). These advances are rapidly becoming available outside academic institutions, and pulmonologists, surgeons and medical oncologists need to understand and critically assess the potential impact of such developments in the routine care of their patients. Aspects of cost-effectiveness of technical innovations, as well as the level of evidence required before widespread clinical implementation, will be addressed.
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Rybovic M, Banati RB, Cox J. Radiation therapy treatment verification imaging in Australia and New Zealand. J Med Imaging Radiat Oncol 2008; 52:183-90. [PMID: 18373812 DOI: 10.1111/j.1440-1673.2008.01940.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An original questionnaire was used to investigate the available types of reference and treatment image verification equipment and specific practices related to image analysis. A section on treatment site-specific imaging was included. The questionnaire was distributed to all radiation oncology facilities in Australia and New Zealand. A response rate of 87% (40/46) was achieved. Most facilities (90%) in Australia and New Zealand reported the availability of electronic portal imaging devices. Use of computer software to assist with image interpretation was indicated by 92% of centres. Frequency of image acquisition and tolerance levels used for radical treatment sites were variable, but palliative treatment site protocols were more consistent between treatment facilities. In conclusion, departments should strive to use evidence-based protocols and guidelines to ensure acceptable accuracy in treatment delivery.
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Affiliation(s)
- M Rybovic
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
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Bentzen SM. Randomized controlled trials in health technology assessment: overkill or overdue? Radiother Oncol 2008; 86:142-7. [PMID: 18237799 PMCID: PMC3539737 DOI: 10.1016/j.radonc.2008.01.012] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 01/14/2008] [Indexed: 11/23/2022]
Abstract
Evidence-based medicine has become a cornerstone in the development of radiation oncology and the randomized controlled phase III trial remains the gold standard for assessing differential benefits in clinical outcome between therapies. Health technologies aimed at improving treatment quality should primarily be tested using process measures or operational characteristics, the reason being that the sensitivity and specificity of clinical outcome is low for detecting quality improvements. The ongoing discussion of the relative merits of intensity modulated photon versus proton radiotherapy is used to illustrate these concepts. Concerns over clinical and individual equipoise as well as the potential limitations of health economics considerations in this setting are also discussed. Working in a technology and science based medical discipline, radiation oncology researchers need to further develop methodology for critical assessment of health technologies as a complement to randomized controlled trials.
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Affiliation(s)
- Søren M Bentzen
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
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The cost of radiation therapy. Radiother Oncol 2008; 86:217-23. [DOI: 10.1016/j.radonc.2008.01.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 01/06/2008] [Accepted: 01/06/2008] [Indexed: 11/21/2022]
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50
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Schulz RJ, Verellen DLJ, Orton CG. Future developments in external beam radiotherapy will be unlikely to significantly improve treatment outcomes over those currently achieved with 3D-conformal and IMRT treatments. Med Phys 2007; 34:3123-6. [PMID: 17879772 DOI: 10.1118/1.2747051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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