Declining brachytherapy utilization for high-risk prostate cancer—Can clinical pathways reverse the trend?

Ling, Diane C.; Karukonda, Pooja; Smith, Ryan P.; Heron, Dwight E.; Beriwal, Sushil

doi:10.1016/j.brachy.2018.08.004

Cited by 9 publications

(5 citation statements)

References 13 publications

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“…41 We recommend that both academic and nonacademic practices consider implementing changes to reverse this worrying trend. 42 Our findings also suggest that a focal boost (like that used in the FLAME trial) to the prostate can provide costeffective care, with an ICER of $62,607 per QALY gained. Interestingly, the focal boost was not cost effective relative to a brachytherapy boost, largely secondary to the increased cost of 35 fractions of EBRT compared with a single procedure of brachytherapy and 23 external-beam treatments.…”

Section: Discussionsupporting

confidence: 52%

“…A National Cancer Database analysis demonstrated that brachytherapy use had declined in both academic and nonacademic practices, raising concerns regarding sufficient brachytherapy training opportunities for trainees 41 . We recommend that both academic and nonacademic practices consider implementing changes to reverse this worrying trend 42 …”

Section: Discussionmentioning

confidence: 96%

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Cost effectiveness of treatment strategies for high risk prostate cancer

Kowalchuk

Kim

Harmsen

et al. 2022

Cancer

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BACKGROUND: Patients with high-risk prostate cancer (HRPC) have multiple accepted treatment options. Because there is no overall survival benefit of one option over another, appropriate treatment must consider patient life expectancy, quality of life, and cost. METHODS:The authors compared quality-adjusted life years (QALYs) and cost effectiveness among treatment options for HRPC using a Markov model with three treatment arms: (1) external-beam radiotherapy (EBRT) delivered with 20 fractions, (2) EBRT with 23 fractions followed by low-dose-rate (LDR) brachytherapy boost, or (3) radical prostatectomy alone. An exploratory analysis considered a simultaneous integrated boost according to the FLAME trial (Clini calTr ials.gov identifier NCT01168479). RESULTS: Treatment strategies were compared using the incremental cost-effectiveness ratio (ICER). EBRT with LDR brachytherapy boost was a cost-effective strategy (ICER, $20,929 per QALY gained). These results were most sensitive to variations in the biochemical failure rate. However, the results still demonstrated cost effectiveness for the brachytherapy boost paradigm, regardless of any tested parameter ranges. Probabilistic sensitivity analysis demonstrated that EBRT with LDR brachytherapy was favored in 52% of 100,000 Monte Carlo iterations. In an exploratory analysis, EBRT with a simultaneous integrated boost was also a cost-effective strategy, resulting in an ICER of $62,607 per QALY gained; however, it was not cost effective compared with EBRT plus LDR brachytherapy boost. CONCLUSIONS: EBRT with LDR brachytherapy boost may be a costeffective treatment strategy compared with EBRT alone and radical prostatectomy for HRPC, demonstrating high-value care. The current analysis suggests that a reduction in biochemical failure alone can result in cost-effective care, despite no change in overall survival.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 96%

Cost effectiveness of treatment strategies for high risk prostate cancer

Kowalchuk

Kim

Harmsen

et al. 2022

Cancer

Self Cite

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“…published in 2010 that there were virtually the same amount of brachytherapy centres in 2002 compared to 2010 and probably the same could be applied here while there is a decreasing trend in other countries [14].…”

Section: Discussionmentioning

confidence: 55%

“…Therefore, brachytherapy can be considered in every localized prostate cancer as it provides excellent biochemical control, with encouraging results in terms of metastatic-free-survival or overall survival [8][9][10][11][12]. Despite this fact, there is a decreasing trend of using prostate brachytherapy, as it requires, a multi-disciplinary team for optimal organization, including operating theatre and anaesthesiology and technical education for a good operator skill [13][14][15]. Considering the incidence rate of prostate cancer to be 100/100 000 men in France and the possible 24% increase of prostate cancer by 2025, it can be argued that the number of patients to be treated for prostate cancer in 2025 can be ranged between 15 000 and 20 000 per year [16,17].…”

Section: Introductionmentioning

confidence: 99%

Brachytherapy boost for prostate cancer: A national survey from Groupe curiethérapie – Société française de radiothérapie oncologique

Kee

Peiffert

Hannoun‐Lévi

2019

Cancer/Radiothérapie

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“…This novel capability may be of particular meaning to brachytherapy. In fact, brachytherapy utilization has experienced a downward trend despite its demonstrated clinical benefits (Ling et al 2018, Schad et al 2020. While the causes are multifactorial, technical burden associated with brachytherapy for accurate, efficient, and safe treatments may be one major factor.…”

Section: Thoughts On Deep Learning In Brachytherapymentioning

confidence: 99%

Emerging technologies in brachytherapy

Song¹,

Robar²,

Morén³

et al. 2021

Phys. Med. Biol.

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Brachytherapy is a mature treatment modality. The literature is abundant in terms of review articles and comprehensive books on the latest established as well as evolving clinical practices. The intent of this article is to part ways and look beyond the current state-of-the-art and review emerging technologies that are noteworthy and perhaps may drive the future innovations in the field. There are plenty of candidate topics that deserve a deeper look, of course, but with practical limits in this communicative platform, we explore four topics that perhaps is worthwhile to review in detail at this time. First, intensity modulated brachytherapy (IMBT) is reviewed. The IMBT takes advantage of anisotropic radiation profile generated through intelligent high-density shielding designs incorporated onto sources and applicators such to achieve high quality plans. Second, emerging applications of 3D printing (i.e. additive manufacturing) in brachytherapy are reviewed. With the advent of 3D printing, interest in this technology in brachytherapy has been immense and translation swift due to their potential to tailor applicators and treatments customizable to each individual patient. This is followed by, in third, innovations in treatment planning concerning catheter placement and dwell times where new modelling approaches, solution algorithms, and technological advances are reviewed. And, fourth and lastly, applications of a new machine learning technique, called deep learning, which has the potential to improve and automate all aspects of brachytherapy workflow, are reviewed. We do not expect that all ideas and innovations reviewed in this article will ultimately reach clinic but, nonetheless, this review provides a decent glimpse of what is to come. It would be exciting to monitor as IMBT, 3D printing, novel optimization algorithms, and deep learning technologies evolve over time and translate into pilot testing and sensibly phased clinical trials, and ultimately make a difference for cancer patients. Today’s fancy is tomorrow’s reality. The future is bright for brachytherapy.

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Declining brachytherapy utilization for high-risk prostate cancer—Can clinical pathways reverse the trend?

Cited by 9 publications

References 13 publications

Cost effectiveness of treatment strategies for high risk prostate cancer

Cost effectiveness of treatment strategies for high risk prostate cancer

Brachytherapy boost for prostate cancer: A national survey from Groupe curiethérapie – Société française de radiothérapie oncologique

Emerging technologies in brachytherapy

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