The cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancers

PURPOSE

Intensity-modulated radiotherapy is developed as a replacement for 3-dimensional conformal radiation therapy. Considering the difference in costs and effectiveness of these interventions, the aim of this study was to compare the cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancer in east of Iran.

METHODS

A Markov model including six states based on xerostomia and dysphagia was developed to estimate the incremental cost effectiveness ratio from the perspective of societal. Cost and quality of life data were collected from 97 respondents via a checklist and EuroQol-5Dimension questionnaire. The robustness of results was examined by deterministic and probabilistic sensitivity analysis. All analysis were conducted with Treeage software.

RESULTS

The results of this study showed that the cost and quality adjusted life years for 3-dimensional conformal radiation therapy were 9209.76 and 3.63 respectively. However, the cost and quality adjusted life years for intensity-modulated radiotherapy were 12562.90 and 3.17 respectively. Therefore, 3-dimensional conformal radiation therapy produced 0.45 more quality adjusted life years than intensity-modulated radiotherapy and saved $3353. According to the incremental cost effectiveness ratio, 3-dimensional conformal radiation therapy as compared to intensity-modulated radiotherapy saved $7367.27 per quality adjusted life years. These results confirmed by sensitivity analysis.

CONCLUSION

This study concluded that in the treatment of head and neck cancer, the 3-dimensional conformal radiation therapy method appears to be cost-effective when compared with intensity-modulated radiotherapy.

Cervical cancer patient reported gastrointestinal outcomes: intensity/volumetric modulated vs. 3D conformal radiation therapy

OBJECTIVE

To evaluate gastrointestinal (GI) patient reported outcomes (PROs) in cervical cancer patients treated with definitive radiotherapy (RT), comparing 3D conformal RT (3DCRT) vs. intensity modulated/volumetric modulated arc therapy (IMRT/VMAT).

METHODS

An analysis of patients treated with definitive RT between 2015-2018 was performed. GI PROs were prospectively collected at baseline, during RT (acute), ≤12 weeks after RT (subacute), and >12 weeks after RT (late). GI PROs evaluated three symptom domains: bowel problems (BPs), bowel bother (BB), and abdominal problems (APs). Multiple linear regression analysis was performed to investigate associations between mean changes of symptom scores with clinical and dosimetric variables.

RESULTS

The cohort included 167 patients. A total of 100 (60%) patients were treated with IMRT/VMAT and 67 (40%) with 3DCRT. In the subacute phase, the mean change of symptom scores from baseline in 3DCRT vs. IMRT/VMAT were +0.9 vs. -1.15 (p=0.004) for BP, +2.18 vs. -0.10 (p=0.019) for BB, and +1.41 vs. -0.38 (p=0.021) for AP. Likewise, in the late phase, mean changes were +0.72 vs. -0.82 (p=0.014) for BP, +1.98 vs. -0.03 (p=0.008) for BB, and +1.29 vs. -0.31 (p<0.001) for AP. On multiple linear regression, use of 3DCRT vs. IMRT/VMAT was associated with greater mean changes in subacute BP (p=0.023) and late phase AP (p=0.019). A higher small bowel V50Gy was associated increased symptom scores in late AP (p=0.012).

CONCLUSION

3DCRT was associated with significantly greater worsening of GI PRO symptom scores in the subacute and late phase. These data support the ongoing use of IMRT/VMAT in routine practice.

Intensity modulated radiotherapy (IMRT) or conformational radiotherapy (3D-CRT) with conventional fractionation for prostate cancer: Is there any clinical difference?

Purpose:

To compare the treatment outcomes of a cohort of prostate cancer patients treated with conventional schedule using IMRT or 3DRT technique.

Materials and Methods:

Between 2010-2017, 485 men with localized prostate cancer were treated with conventional radiotherapy schedule with a total dose ≥74Gy using IMRT (231) or 3DCRT (254). Late gastrointestinal (GI) and genitourinary (GU) toxicity were retrospectively evaluated according to modified RTOG criteria. The biochemical control was defined by the Phoenix criteria (nadir + 2ng/mL). The comparison between the groups included biochemical recurrence free survival (bRFS), overall survival (OS) and late toxicity.

Results:

With a median follow-up of 51 months (IMRT=49 and 3DRT=51 months), the maximal late GU for >=grade- 2 during the entire period of follow-up was 13.1% in the IMRT and 15.4% in the 3DRT (p=0.85). The maximal late GI ≥ grade- 2 in the IMRT was 10% and in the 3DRT 24% (p=0.0001). The 5-year bRFS for all risk groups with IMRT and 3D-CRT was 87.5% vs. 87.2% (p=0.415). Considering the risk-groups no significant difference for low-, intermediate- and high-risk groups between IMRT (low-95.3%, intermediate-86.2% and high-73%) and 3D-CRT (low-96.4%, intermediate-88.2% and high-76.6%, p=0.448) was observed. No significant differences for OS and DMFS were observed comparing treatment groups.

Conclusion:

IMRT reduces significantly the risk of late GI severe complication compared with 3D-CRT using conventional fractionation with a total dose ≥74Gy without any differences for bRFS and OS.