The role of radiotherapy in cancer treatment - Estimating optimal utilization from a review of evidence-based clinical guidelines
The role of radiotherapy in cancer treatment - Estimating optimal utilization from a review of evidence-based clinical guidelines
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DOI：
10.1002/cncr.21324
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发表时间：
2005-09-15
期刊：
影响因子：
6.2
通讯作者：
Barton, M
中科院分区：
文献类型：
--
作者：
Delaney, G;Jacob, S;Barton, M
癌症的放射治疗利用率在国际上差异很大。以前曾有人建议，大约50%的癌症患者应该接受放射治疗。然而，这一估计并不是以证据为基础的。这项研究的目的是根据现有的最佳证据，估计在其疾病过程中应至少接受一次放射治疗的癌症新发病例的理想比例。根据循证治疗指南中的放疗适应症，为每种癌症构建了最佳放疗利用树。通过将流行病学数据添加到放射治疗利用树中，获得具有表明可能从放射治疗获益的临床属性的患者比例。然后使用TreeAge（TreeAge Software，Williamstown，MA）软件计算应接受放射治疗的癌症患者的最佳比例。采用单变量分析和Monte Carlo模拟进行敏感性分析。根据现有最佳证据计算，需要进行外照射放疗的癌症患者比例为52%。Monte Carlo分析表明，95%置信区间为51.7%~ 53.1%。置信区间的紧密性表明总体估计是稳健的。与实际放射治疗利用数据的比较表明，实际放射治疗提供不足。该方法允许将最佳比率与实际比率进行比较，以确定在循证使用放射治疗方面可以改进的领域。为放射治疗服务规划提供了有价值的数据。需要解决实际比率问题，以确保更好地利用放射治疗。
Radiotherapy utilization rates for cancer vary widely internationally. It has previously been suggested that approximately 50% of all cancer patients should receive radiation. However, this estimate was not evidence-based. The aim of this study was to estimate the ideal proportion of new cases of cancer that should receive radiotherapy at least once during the course of their illness based on the best available evidence. An optimal radiotherapy utilization tree was constructed for each cancer based upon indications for radiotherapy taken from evidence-based treatment guidelines. The proportion of patients with clinical attributes that indicated a possible benefit from radiotherapy was obtained by adding epidemiologic data to the radiotherapy utilization tree. The optimal proportion of patients with cancer that should receive radiotherapy was then calculated using TreeAge (TreeAge Software, Williamstown, MA) software. Sensitivity analyses using univariate analysis and Monte Carlo simulations were performed. The proportion of patients with cancer in whom external beam radiotherapy is indicated according to the best available evidence was calculated to be 52%. Monte Carlo analysis indicated that the 95% confidence limits were from 51.7% to 53.1%. The tightness of the confidence interval suggests that the overall estimate is robust. Comparison with actual radiotherapy utilization data suggests a shortfall in actual radiotherapy delivery. This methodology allows comparison of optimal rates with actual rates to identify areas where improvements in the evidence-based use of radiotherapy can be made. It provides valuable data for radiotherapy service planning. Actual rates need to be addressed to ensure better radiotherapy utilization.