Intensity-modulated radiotherapy (IMRT) - KCE

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Intensity-modulated radiotherapy (IMRT) - KCE

40 Intensity-modulated radiotherapy KCE reports 62

7.2.3 Assumptions for IMRT delivery

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The principal therapeutic assumption we made is that patients being treated with IMRT

would otherwise, i.e. in absence of IMRT as a therapeutic choice, have been treated

with 3DCRT (prostate cancer, head and neck cancer) or 2DRT (breast cancer) f . The

main implication of this assumption is that alternative treatment shifts, e.g. from patients

who would have been treated (exclusively) with brachytherapy for prostate cancer, are

excluded from our analysis. Given the absence of data on the clinical outcome of

therapeutic substitution between IMRT and brachytherapy in prostate cancer patients, it

was deemed judicious to approach the introduction of IMRT as a “ceteris paribus”

transition from patients treated with 3DCRT to patients treated with IMRT. This

assumption is corroborated by Figure 4, indicating no apparent substitution effects have

been playing that would divert patient treatment preferentially to IMRT. It would also

seem that the newly introduced regulation on the reimbursement of investment and

operational costs from April 2005 on has not considerably influenced the delivery of

brachytherapy. As the new regulation is solely based on the number of deliveries

through categories 1-4 it tends to favour the implementation of brachytherapy

(categories 6-10) less than the former regulation did.

Figure 4 Brachytherapy versus IMRT under article 18: number of treatment

courses

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External beam radiotherapy uptake as a percentage of newly diagnosed patients by

tumour type was derived from CCORE 2003 105 . This publication sets “optimal”, i.e.

evidence-based, radiotherapy uptake rates through a systematic review for a

comprehensive range of cancers with a view to facilitating further planning efforts for

external radiotherapy infrastructure needs. These data have already been applied

internationally in estimating external radiotherapy investment costs 106 107 98 . Table 13

summarizes the uptake rates that are most pertinent to our analysis.

Table 13 Uptake rate for external beam radiotherapy by type of cancer

Tumour type Proportion of all cancers Patients receiving RT (%)

Breast 13% 83%

Prostate 12% 60%

Head and Neck 4% 78%

f At present, breast cancer patients are excluded from reimbursement for 3DCRT (see appendix 6).

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Article 18: Exclusive Treatment With

Brachytherapy (categories 7-10)

Article 18: Exclusive Treatment With

IMRT

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