ESTRO 2023 - Abstract Book

S619

Monday 15 May 2023

ESTRO 2023

surgery, 18% predominantly by RT alone or in combination, and 5% predominantly by chemotherapy alone or in combination. Normalising these estimates gives values for predominant cure of 49%, 40% and 11% for surgery, radiotherapy and chemotherapy respectively. The 40% figure for radiotherapy has been widely quoted. We aimed to review these figures, not updated since 1992, using the comprehensive cancer and follow-up data gathered in NHS England. Materials and Methods In this retrospective population-based study we analysed 5-years of patients who developed their first tumour and had 5- years of vital-status updates. All tumour sites (excluding C44) and all ages were included. We analysed three cohorts: all patients [n=1,032,557], patients who survived 5 years [n=540,753] and patients who did not survive 5 years [n=491,804]. Treatment data was analysed to identify patients who received at least one course of radiotherapy, chemotherapy and/or surgery. Results Overall 5 year survival was 52% (540,753 patients). Of these, 90% had at least one record of surgery, radiotherapy or chemotherapy; 80% receiving surgery either alone or in combination; radiotherapy was delivered to 39% and chemotherapy to 29%. 45% received 2 or 3 modalities and 13% received all 3. Figure 1 displays the results for all treatment combinations. In the cohort who did not survive 5-years, 46% received surgery alone or in combination, 30% radiotherapy and 34% chemotherapy, the latter being the only modality with increased use.

Conclusion By using 5-year survival from diagnosis, we have data at a well-defined time-point that is easily interpretable in a patient cohort managed using the most contemporaneous treatments. The finding of 52% 5 year survival in > 1 million ‘real world’ cancer patients treated within NHS England is broadly consistent with overall UK figures. There are no equivalent modern, international studies. We recommend this exercise be repeated every 10 years. These results indicate the dominant role of surgery in cancer survival and that both radiotherapy and chemotherapy play vital curative roles. The high rate of multi-modality treatment, used in 45% of patients surviving 5 years and probably still increasing, is striking and underlines the importance of integrated services within a national strategy. Our results are remarkably similar to those from Tubiana in 1992 regarding the role of radiotherapy. The fact that radiotherapy contributes significantly to 5-year survival, being delivered to almost 40% of patients, is a critical conclusion. It is contrary to popular perception and should be addressed by more informed public health messaging. It is also critical for service planning. OC-0753 Introduction of ultra-hypofractionation in breast cancer: implications for costs and resource use S. Busschaert 1 , K. Putman 2 , M. De Ridder 3 1 Vrije Universiteit Brussel , Public Health Sciences, Brussels, Belgium; 2 Vrije Universiteit Brussel, Public Health Sciences, Brussels, Belgium; 3 Vrije Universiteit Brussel, Clinical Sciences, Brussels, Belgium Purpose or Objective The objectives are twofold: (1) to calculate the costs of and resources consumed by different fractionation schedules in breast cancer, and (2) to model the consequences of adopting ultra-hypofractionation as the standard procedures for work times, costs, resource utilisation and throughput. Materials and Methods Time-driven activity-based costing (TD-ABC) is applied to calculate the costs and resources consumed where the perspective of the radiotherapy department in adopted. Three fractionation schedules are considered: ultra-hypofractionation (5 x 5.2 Gy, UHF), hypofractionation (15 x 2.67 Gy, HF) and normofractionation (25 x 2 Gy, NF). Subsequently, a discrete event simulation (DES) model of the radiotherapy care pathway is developed and scenarios are compared in which the following factors are varied: distribution of fractionation schedules (100% adoption of UHF vs. 100% adoption of HF vs. 100% adoption of NF vs. mixed schedule (i.e. UHF for node-negative (68%) and HF for node-positive breast cancer), patient volume (low caseload – 250 patients per year vs. medium caseload – 500 patients per year vs. high caseload – 750 patients per year).