Evidence-based population model of local control and overall survival benefit of radiotherapy

J Shafiq, TP Hanna, GP Delaney, MB Barton

Collaboration for Cancer Outcome, Research and Evaluation

(CCORE), Ingham Institute for Applied Medical Research, UNSW

Australia

Radiotherapy utilisation

Source: Atun R et al, Expanding global access to radiotherapy, Lancet Oncol 2015; 16: 1153–86

• Population - All patients in a region with a given cancer or group of cancers

• Population-based demand models provide means for (Hanna and

Shafiq, 2015)

• Estimating optimal proportion needing treatment

• Treatment benefit achievable under optimal condition

• Can be used for different treatment modalities and different outcomes

Population-based model

• Radiotherapy indications are based on evidence of superior clinical outcomes (Delaney et al 2003)

• Population-based radiotherapy utilisation (RTU) model

• 48% of all cancer patients need radiotherapy (Barton et al 2012)

• RTU models further extended to estimate the local control and overall survival benefits

Radiotherapy utilisation and benefit models

Methods flowchart

Evidence

PMRT 1-3 nodes PMRT 4+ nodes

Source: EBCTCG 2014

Benefit models

Brain

Breast

Head and Neck

Gastrointestinal

Genitourinary

Gynaecological

Haematological

Lung

Melanoma

Unknown Primary

Other: Anus, Small intestine, Biliary tract, Mesothelioma, Myelodysplastic syndrome, Non-melanoma skin cancer, Sarcomas and rare cancer

5-yr OS model- lung cancer

Benefit for top most cancers in Australia

Prostate 25% 0% 25% 1% 0% 1%

Colon 0% 0% 0% 0%

Rectum 8% 5% 13% 4% 2% 6%

Breast 15% 0% 15% 2% 0% 2%

Melanoma 3% 0% 3% 0% 0%

Lung 7% 2% 9% 4% 1% 5%

RT alone

vs No RT

5-yr LC benefit 5-yr OS benefit

(%) (%)

RT alone

vs No RT

Concurrent

CRT vs RT

alone

Total

Concurrent

CRT vs RT

alone

Total

5-yr LC benefit by cancer sites

5-yr OS benefit by cancer sites

Sensitivity analysis

2.29% 2.35% 2.45%

• The model estimate of benefits with 95% CI

A) Radiotherapy alone:

• 5-year local control – 10.8% (9.3,11.8)

• 5-year overall survival – 2.4% (2.1, 2.7)

B) Concurrent chemo-radiotherapy:

• 5-year local control – 0.5% (0.5,0 0.6)

• 5-year overall survival – 0.3% (0.2, 0.4)

Population benefit for all cancers

If guidelines recommended radiotherapy is applied to whole cancer population

• For 123532 new cancer cases in Australia (AIHW 2013)

• 5-year local control benefit in 13571 cases

• 5-year overall survival benefit in 3485 cases

• If only curative radiotherapy indications are considered the no. of people with benefit would be doubled

Conclusion

The potential for evidence-based models

• To inform economic analyses of treatment service need

• To assess shortfalls in service provision at the population level

• Planning for equitable services across population

Future work

1. Hanna TP, Shafiq J, Vinod SK, Thompson SR, Delaney GP, Barton MB. The Population Benefit of Evidence-based Radiotherapy: 5-year Local Control and Overall Survival Benefits. Radiotherapy and Oncology 2017 (Submitted)

2. Yap ML, Hanna TP, Shafiq J, Ferlay J, Bray F, Delaney GP, Barton M.The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries.Clin Oncol (R Coll Radiol). 2017 Feb;29(2):72-83.

3. Shafiq J, Hanna TP, Vinod SK, Delaney GP, Barton MB. A Population-based Model of Local Control and Survival Benefit of Radiotherapy for Lung Cancer. Clin Oncol (R Coll Radiol). 2016;28(10):627-38.5.

4. Hanna TP, Delaney GP, Barton MB. The population benefit of radiotherapy for gynaecological cancer: Local control and survival estimates. Radiotherapy and Oncology. 2016;120(3):370-377.

5. Hanna TP, Shafiq J. Estimating the population benefit of radiotherapy: using demand models to estimate achievable cancer outcomes. Clin Oncol (R Coll Radiol) 2015 Feb;27(2):99-106.

6. Barton MB, Jacob S, Shafiq J, Wong K, Thompson SR, Hanna TP, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiotherapy and oncology 2014;112(1):140-4.

7. Shafiq J, Delaney G, Barton MB. An evidence-based estimation of local control and survival benefit of radiotherapy for breast cancer. Radiotherapy and Oncology 2007;84:11-7.

8. Delaney G, Jacob S, Featherstone C, Barton MB. The role of radiotherapy in cancer treatment. Estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 2005;104(6):1129-37.

Publications

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