T P Hanna1, J Shafiq2, G P Delaney3, S K Vinod4, S R Thompson5, M B Barton3. 1. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia; Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, Canada. Electronic address: thanna@kgh.kari.net. 2. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia; South Western Sydney Clinical School, UNSW, Sydney, Australia. 3. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia. 4. South Western Sydney Clinical School, UNSW, Sydney, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia. 5. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales (UNSW), Liverpool, Australia; Department of Radiation Oncology, Prince of Wales Hospital, Sydney, Australia.
Abstract
BACKGROUND: To describe the population benefit of radiotherapy in a high-income setting if evidence-based guidelines were routinely followed. METHODS: Australian decision tree models were utilized. Radiotherapy alone (RT) benefit was defined as the absolute proportional benefit of radiotherapy compared with no treatment for radical indications, and of radiotherapy over surgery alone for adjuvant indications. Chemoradiotherapy (CRT) benefit was the absolute incremental benefit of concurrent chemoradiotherapy over RT. Five-year local control (LC) and overall survival (OS) benefits were measured. Citation databases were systematically queried for benefit data. Meta-analysis and sensitivity analysis were performed. FINDINGS: 48% of all cancer patients have indications for radiotherapy, 34% curative and 14% palliative. RT provides 5-year LC benefit in 10.4% of all cancer patients (95% Confidence Interval 9.3, 11.8) and 5-year OS benefit in 2.4% (2.1, 2.7). CRT provides 5-year LC benefit in an additional 0.6% of all cancer patients (0.5, 0.6), and 5-year OS benefit for an additional 0.3% (0.2, 0.4). RT benefit was greatest for head and neck (LC 32%, OS 16%), and cervix (LC 33%, OS 18%). CRT LC benefit was greatest for rectum (6%) and OS for cervix (3%) and brain (3%). Sensitivity analysis confirmed a robust model. INTERPRETATION: Radiotherapy provides significant 5-year LC and OS benefits as part of evidence-based cancer care. CRT provides modest additional benefits.
BACKGROUND: To describe the population benefit of radiotherapy in a high-income setting if evidence-based guidelines were routinely followed. METHODS: Australian decision tree models were utilized. Radiotherapy alone (RT) benefit was defined as the absolute proportional benefit of radiotherapy compared with no treatment for radical indications, and of radiotherapy over surgery alone for adjuvant indications. Chemoradiotherapy (CRT) benefit was the absolute incremental benefit of concurrent chemoradiotherapy over RT. Five-year local control (LC) and overall survival (OS) benefits were measured. Citation databases were systematically queried for benefit data. Meta-analysis and sensitivity analysis were performed. FINDINGS: 48% of all cancerpatients have indications for radiotherapy, 34% curative and 14% palliative. RT provides 5-year LC benefit in 10.4% of all cancerpatients (95% Confidence Interval 9.3, 11.8) and 5-year OS benefit in 2.4% (2.1, 2.7). CRT provides 5-year LC benefit in an additional 0.6% of all cancerpatients (0.5, 0.6), and 5-year OS benefit for an additional 0.3% (0.2, 0.4). RT benefit was greatest for head and neck (LC 32%, OS 16%), and cervix (LC 33%, OS 18%). CRT LC benefit was greatest for rectum (6%) and OS for cervix (3%) and brain (3%). Sensitivity analysis confirmed a robust model. INTERPRETATION: Radiotherapy provides significant 5-year LC and OS benefits as part of evidence-based cancer care. CRT provides modest additional benefits.
Authors: J López-Torrecilla; D González Sanchis; D Granero Cabañero; E García Miragall; P Almendros Blanco; A Hernandez Machancoses; L Brualla González; J Pastor Peidro; J C Gordo Partearroyo; J Rosello Ferrando Journal: Clin Transl Oncol Date: 2021-02-14 Impact factor: 3.405
Authors: Brian D Yard; Priyanka Gopal; Kristina Bannik; Gerhard Siemeister; Urs B Hagemann; Mohamed E Abazeed Journal: Cancer Res Date: 2019-08-06 Impact factor: 12.701
Authors: Bróna Nic Giolla Easpaig; Gaston Arnolda; Yvonne Tran; Mia Bierbaum; Klay Lamprell; Geoffrey P Delaney; Winston Liauw; Renuka Chittajallu; Teresa Winata; Robyn L Ward; David C Currow; Ian Olver; Jonathan Karnon; Johanna Westbrook; Jeffrey Braithwaite Journal: BMJ Open Date: 2019-10-10 Impact factor: 2.692