ESTRO 2022 - Abstract Book

S454

Abstract book

ESTRO 2022

OC-0505 Coverage with evidence development: generating real-life evidence on SBRT in Belgium.

Y. Lievens 1 , L. Boesmans 2 , H. Engels 3 , X. Geets 4 , N. Jansen 5 , S. Janssens 2 , M. Lambrecht 6 , V. Remouchamps 7 , S. Roosens 3 , K. Stellamans 8 , D. Verellen 9 , C. Weltens 6 , R. Weytjens 9 , N. Van Damme 2 1 Ghent University Hospital and Ghent University, Radiation Oncology Department, Ghent, Belgium; 2 Belgian Cancer Registry, NA, Brussels, Belgium; 3 Belgian National Institute for Health and Disability Insurance, NA, Brussels, Belgium; 4 Cliniques Universitaires Saint-Luc, Radiation Oncology Department, Brussels, Belgium; 5 CHU de Liège, Radiation Oncology Department, Liège, Belgium; 6 University Hospital Leuven, Radiation Oncology Department, Leuven, Belgium; 7 CHU UCL Namur, Site Sainte Elisabeth, Belgium., Radiation Oncology Department, Namur, Belgium; 8 AZ Groeninge, Radiation Oncology Department, Kortrijk, Belgium; 9 Iridium Netwerk and Antwerp University, Radiation Oncology and Faculty of Medicine and Health Sciences, Antwerp, Belgium Purpose or Objective While stereotactic body radiotherapy (SBRT) increasingly gained interest and was progressively implemented across Belgium, reimbursement was not granted in 2011 for lacking data on outcome, costs, cost-effectiveness and budget impact of SBRT from a Belgian perspective. To allow early access of patients to this promising treatment technique, and to support real-life data collection, a coverage with evidence development (CED) program started in 2013. The aim was to examine the conditions under which SBRT could be included in the medical nomenclature. Materials and Methods After defining the level for provisional financing with time-driven activity-based costing, a prospective 'Innovative Radiotherapy Techniques' registration project was initiated by the Belgian National Institute for Health and Disability Insurance (NIHDI), enrolling radiation oncology centers using SBRT in clinical practice. Participating centers signed the ‘NIHDI convention’, agreeing to treat patients from pre-determined target groups (primary tumors (PT) or oligometastatic disease (OMD)) with SBRT and to register clinical and technical data in exchange for temporary research funding. ‘Standard’ vs. ‘non-standard’ indications were defined, the latter requiring additional enrollment in a clinical trial to be eligible for registration and financing. A dedicated registration module was available online at the Belgian Cancer Registry website. Survival outcome was obtained by August, 9 th 2021. Results The project ran from 10/2013 until 12/2019. The centers registering patients progressively increased from 3 (out of 25 accredited radiation oncology centers) in 2013 to 18/25 in 2019. During the entire period, 20 RT centers participated. A total of 6,296 registrations were included in the project. After data cleaning, 5,675 SBRTs were retained for final analysis, with an average of 284 per center (range 21-951). 2,885 (51%) pertained to PT, with a majority of lung, prostate and (para)vertebral tumors (n=2,801, 97%; n=49, 1.7% and n=16, 0.6%, respectively), all ‘standard’ indications. For OMD, 2,348 ‘standard indications’ were registered (lung: n=1,484, 53%; (para)spinal: n=537, 19%; and liver metastases: n=327, 12%); and 442 (16%) ‘non-standard’ metastases, mainly lymph nodes and non-paraspinal bones. Over time, SBRT for OMD progressively outnumbered PTs. Moreover, outcome seems to improve while implementation progresses. Most important variables are shown in Table 1; Kaplan-Meyer overall survival curves for the 6 most frequent indications, in Figure 1.