Decision analytic modeling for the economic analysis of proton radiotherapy for non-small cell lung cancer

Smith, W. P.; Richard, Patrick; Zeng, Jing; Apisarnthanarax, Smith; Rengan, Ramesh; Phillips, Mark H.

doi:10.21037/tlcr.2018.03.27

Cited by 9 publications

(13 citation statements)

References 40 publications

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“…There are some potential drawbacks in utilizing PBSPT. First, overall costs of PBT easily exceed those of photon RT, even after toxicity rate-adjusted analysis [ 37 ]. However, PBT increased the quality-adjusted life-years by 0.549 and 0.452 compared to 3D CRT/IMRT [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Pencil Beam Scanning Proton Therapy in Locally Advanced Non-Small Cell Lung Cancer: Propensity Score Analysis

Kim

Noh

Lee

et al. 2021

Cancers

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This study compared the efficacy and safety of pencil beam scanning proton therapy (PBSPT) versus intensity-modulated (photon) radiotherapy (IMRT) in patients with stage III non-small cell lung cancer (NSCLC). We retrospectively reviewed 219 patients with stage III NSCLC who received definitive concurrent chemoradiotherapy between November 2016 and December 2018. Twenty-five patients (11.4%) underwent PBSPT (23 with single-field optimization) and 194 patients (88.6%) underwent IMRT. Rates of locoregional control (LRC), overall survival, and acute/late toxicities were compared between the groups using propensity score-adjusted analyses. Patients treated with PBSPT were older (median: 67 vs. 62 years) and had worse pulmonary function at baseline (both FEV1 and DLCO) compared to those treated with IMRT. With comparable target coverage, PBSPT exhibited superior sparing of the lung, heart, and spinal cord to radiation exposure compared to IMRT. At a median follow-up of 21.7 (interquartile range: 16.8–26.8) months, the 2-year LRC rates were 72.1% and 84.1% in the IMRT and PBSPT groups, respectively (p = 0.287). The rates of grade ≥ 3 esophagitis were 8.2% and 20.0% after IMRT and PBSPT (p = 0.073), respectively, while corresponding rates of grade ≥ 2 radiation pneumonitis were 28.9% and 16.0%, respectively (p = 0.263). PBSPT appears to be an effective and safe treatment technique even for patients with poor lung function, and it does not jeopardize LRC.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Pencil Beam Scanning Proton Therapy in Locally Advanced Non-Small Cell Lung Cancer: Propensity Score Analysis

Kim

Noh

Lee

et al. 2021

Cancers

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“…Grutters et al [74] recommended not adopting proton as a standard treatment for NSCLC. Though current costs favor photon therapy in most studies, the preference for proton therapy may be found with relatively small reductions in the cost of proton therapy [72]. Therefore, it is hard to draw a conclusion now, based on the present limited evidence of cost-effectiveness for proton therapy over other therapies in treating lung cancer.…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…Compared with photon therapy, the initial cost was 2.4-fold higher for proton therapy, however, after adding the costs of treating adverse effects, the total cost was reduced by 2.6-fold for proton therapy [70,71]. In a recent report using an influence diagram to model for radiation delivery in lung cancer, the overall costs (radiation plus toxicity costs) and upfront proton treatment costs exceeded that of photons [72]. The relatively lower rate of pneumonitis and esophagitis rates help protons to recover some of the total cost.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Dosimetry, Efficacy, Safety, and Cost-Effectiveness of Proton Therapy for Non-Small Cell Lung Cancer

Qiu

Men

Wang

et al. 2021

Cancers

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Non-small cell lung cancer (NSCLC) is the most common malignancy which requires radiotherapy (RT) as an important part of its multimodality treatment. With the advent of the novel irradiation technique, the clinical outcome of NSCLC patients who receive RT has been dramatically improved. The emergence of proton therapy, which allows for a sharper dose of build-up and drop-off compared to photon therapy, has potentially improved clinical outcomes of NSCLC. Dosimetry studies have indicated that proton therapy can significantly reduce the doses for normal organs, especially the lung, heart, and esophagus while maintaining similar robust target volume coverage in both early and advanced NSCLC compared with photon therapy. However, to date, most studies have been single-arm and concluded no significant changes in the efficacy for early-stage NSCLC by proton therapy over stereotactic body radiation therapy (SBRT). The results of proton therapy for advanced NSCLC in these studies were promising, with improved clinical outcomes and reduced toxicities compared with historical photon therapy data. However, these studies were also mainly single-arm and lacked a direct comparison between the two therapies. Currently, there is much emerging evidence focusing on dosimetry, efficacy, safety, and cost-effectiveness of proton therapy for NSCLC that has been published, however, a comprehensive review comparing these therapies is, to date, lacking. Thus, this review focuses on these aspects of proton therapy for NSCLC.

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“…18,20,21 Based on other literature found in the scoping review, PT was recommended for patients with early-stage or locally advanced NSCLC patients at high risk of developing severe acute side effects (e.g. elderly), 10,31,40 patients with tumours located centrally and close to the brachial plexus, and patients whose tumours or nodal involvement overlapped with or was inferior to T7. 46 Verma et al 13 and Smith et al 63 alternatively found PT was not effective for early-stage lung cancer or low-risk groups where cost differences between conventional and PT were minimal.…”

Section: Lung Tumoursmentioning

confidence: 99%

A scoping review of patient selection methods for proton therapy

Zientara

Giles

et al. 2021

J of Medical Radiation Sci

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The aim was to explore various national and international clinical decisionmaking tools and dose comparison methods used for selecting cancer patients for proton versus X-ray radiation therapy. To address this aim, a literature search using defined scoping review methods was performed in Medline and Embase databases as well as grey literature. Articles published between 1 January 2015 and 4 August 2020 and those that clearly stated methods of proton versus X-ray therapy patient selection and those published in English were eligible for inclusion. In total, 321 studies were identified of which 49 articles met the study's inclusion criteria representing 13 countries. Six different clinical decision-making tools and 14 dose comparison methods were identified, demonstrating variability within countries and internationally. Proton therapy was indicated for all paediatric patients except those with lymphoma and re-irradiation where individualised model-based selection was required. The most commonly reported patient selection tools included the Normal Tissue Complication Probability model, followed by cost-effectiveness modelling and dosimetry comparison. Model-based selection methods were most commonly applied for head and neck clinical indications in adult cohorts (48% of studies). While no 'Gold Standard' currently exists for proton therapy patient selection with variations evidenced globally, some of the patient selection methods identified in this review can be used to inform future practice in Australia. As literature was not identified from all countries where proton therapy centres are available, further research is needed to evaluate patient selection methods in these jurisdictions for a comprehensive overview.

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Decision analytic modeling for the economic analysis of proton radiotherapy for non-small cell lung cancer

Cited by 9 publications

References 40 publications

Clinical Outcomes of Pencil Beam Scanning Proton Therapy in Locally Advanced Non-Small Cell Lung Cancer: Propensity Score Analysis

Clinical Outcomes of Pencil Beam Scanning Proton Therapy in Locally Advanced Non-Small Cell Lung Cancer: Propensity Score Analysis

Dosimetry, Efficacy, Safety, and Cost-Effectiveness of Proton Therapy for Non-Small Cell Lung Cancer

A scoping review of patient selection methods for proton therapy

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