MODEL OF ESTIMATION OF LOCAL CONTROL AND SURVIVAL BENEFIT OF EXTERNAL BEAM RADIOTHERAPY FOR SELECTED CANCERS

Aims The aim of this study was to estimate the population-based local control (LC) and overall survival (OS) benefits of radiotherapy for selected cancers if the whole cancer population in Australia were treated according to evidence-based guidelines. These estimates were based on the published radiotherapy utilisation (RTU) models used for estimating demand of radiotherapy services nationally and internationally. Methods Benefits were defined as the LC and OS proportional gains from radiotherapy over no radiotherapy and from post-operative radiotherapy over surgery alone. CRT benefits were the proportional gains from concurrent radiotherapy and chemotherapy over radiotherapy alone. The RTU models for breast, gastro-intestinal (oesophagus, stomach, colorectal, gall bladder, pancreas), haematological (leukaemia, lymphoma, myeloma), lung, melanoma, unknown primary and ‘other’ (anus, non-melanoma skin cancer, soft tissue sarcoma) cancers were extended to incorporate benefit estimates of radiotherapy alone (RT alone) and of radiotherapy with concurrent chemotherapy (CRT). Literature review (1990-2015) was conducted to identify benefit estimates of individual radiotherapy indications and summed to estimate the population-based gains for these outcomes. Model robustness was tested through univariate and multivariate sensitivity analyses. Results For the RT alone model, the lowest 5-year LC benefit estimates (benefit %, 95% Confidence Interval) were for leukaemia (1%, 0.2%-1%) and oesophageal cancer (1%, 0.5%-1%), the highest for breast cancer (15%, 12.9%-16.8%). The lowest and highest for 5-year OS benefit were: oesophageal cancer (0.1%, 0.06%-0.13%) and lymphoma (6.5%, 5.9%-7.1%). For the CRT model, lowest and highest LC benefits were for: ‘other’ cancers (1%, 0.2%-1.3%) and rectal cancer (6%, 2.5%-9.4%). 5-year OS benefit ranges were: ‘other’ cancers (0.2%, -0.1%-0.4%) and oesophageal cancer (2%, 1.7%-2.7%). 2-year OS benefits (RT only + CRT) were estimated for lung cancer (13%), pancreatic cancer (3%) and 10-year OS benefits (4%) were estimated for breast cancer. Conclusions The model provided estimates of radiotherapy benefits achievable if treatment guidelines are followed for all cancer patients in the Australian population. This is a unique estimate to examine effects of shortfall in radiotherapy utilisation at a population level. The model can be adapted to populations with known epidemiological parameters to ensure the planning of equitable radiotherapy services worldwide.

Grantor dc:publisher

UNSW, Sydney

Year dc:date

2016

Author dc:creator

• Shafiq, Rokeya Jesmin

• Radiotherapy
• Survival
• Local control

Statement dc:rights

• open access
• CC BY-NC-ND 3.0
• free_to_read

Licence

• https://purl.org/coar/access_right/c_abf2
• https://creativecommons.org/licenses/by-nc-nd/3.0/au/

Language dc:language

EN

Identifier

https://doi.org/10.26190/unsworks/19299

OAI identifier oai:identifier

oai:unsworks.library.unsw.edu.au:1959.4/57056