ESTRO 2023 - Abstract Book

S623

Monday 15 May 2023

ESTRO 2023

The first group included 11 systems, categorising innovations according to the perceived magnitude of innovation, with typically a ‘minor’ versus a ‘major’ group. Appraisal shows that differences between these groups is expressed in 5 different ways: resources required, (expected) impact on patients, degree of difference with standard practice, the amount of training or staff required, and a degree of impact on a business model. These levels of magnitude are labelled, for example, as ‘incremental vs. stepwise’ or ‘continuous vs. discontinuous’ innovations. The remaining 4 systems categorised the innovations according to radiotherapy specific characteristics, such as the type of radiation equipment, mode of delivery, or radiobiological properties. In this more narrative approach, commonly used terms as ‘technique’ or ‘treatment’ are used in different meanings. Conclusion This literature review shows there is no widely accepted classification system for innovative interventions in RO. Two major approaches to categorize innovations were identified, suggesting these may be key characteristics of RO that can be used for classification. Still, there remains room for interpretation and a need for a clear terminology denoting commonly used RO characteristics. Building on these data, the ESTRO-HERO project will define what is required for a categorisation of RO innovations in a value-based healthcare context. These categories should help prioritise what outcomes or level of evidence is required to justify implementation or reimbursement, facilitating early access to innovations that could benefit the patient. OC-0757 Radiotherapy treatment volume and associated patient outcomes: a systematic review and meta-analysis J.Y.A. Kyaw 1 , A. Aggarwal 2 , A. Rendall 2 , E. Gillespie 3 , A. Tree 4 , Y. Lievens 5 , T. Roques 6 , C. Frampton 7 1 Oxford University Hospitals NHS Foundation Trust HOSPITALS NHS FOUNDATION TRUST, Medicine, Oxford, United Kingdom; 2 Guy’s and St Thomas’ NHS Foundation Trust, London, Clinical Oncology, London, United Kingdom; 3 Memorial Sloan Kettering Cancer Center, Clinical Oncology, New York, USA; 4 The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Clinical Oncology, London, United Kingdom; 5 Department of Radiation Oncology, Ghent University Hospital and Ghent University, Clinical Oncology, Ghent, Belgium; 6 Norfolk and Norwich University Hospitals, Clinical Oncology, Norfolk and Norwich, United Kingdom; 7 University of Otago, Medicine, Christ Church, New Zealand Purpose or Objective Evidence of a volume-outcome association in cancer surgery has shaped the centralisation of cancer services, however it is unknown whether a similar association exists for radiotherapy. The aim of this study was to determine the association between radiotherapy treatment volume and patient outcomes. Materials and Methods MEDLINE, EMBASE and citation searches of selected articles between January 1995 to January 2022 were undertaken. Selected studies included 1) patients who underwent curative radiotherapy; 2) hospital volume reported as a predictor variable; and 3) at least two hospital facilities. PRISMA guidelines were used for abstracting data. Independent extraction was undertaken by two reviewers. For the meta- analysis, a random effects model was used. The Newcastle-Ottawa Scale was used for appraising study quality. Absolute effects and hazard ratios (HRs) were used to compare outcomes such as overall survival, death, recurrence, or treatment related complication. For the studies that categorised volume into tertiles and quartiles, the meta-analysis used the hazard ratio of the lowest-volume group (reference) and the next lowest group to determine the most conservative pooled radiotherapy treatment volume and outcome relationship. Results The search identified 4356 papers. The association between radiotherapy volume and patient outcomes was assessed in 21 studies. The majority looked at head and neck cancers (HNCs) (n=7/21). The remaining studies covered cervical (n=4/21), prostate (n=4/21), bladder (n=3/21), lung (n=2/21), anal (n=2/21), oesophageal (n=2/21), brain (n=2/21), liver (n=1/21), and pancreatic cancer (n=1/21). The meta-analysis demonstrated that high-volume radiotherapy facilities (HVRFs) were associated with a lower chance of death compared to low-volume radiotherapy facilities (pooled HR 0.91; 95%CI 0.87-0.95) (See Figure 2). HNCs had the strongest evidence of a volume-outcome association for both nasopharyngeal cancer (pooled HR 0.74; 95%CI 0.62-0.89) and non-nasopharyngeal HNC subsites (pooled HR 0.80; 95%CI 0.75-0.84) followed by prostate (pooled HR 0.92; 95%CI 0.86-0.98) cancer. The remaining cancer types showed weak evidence of an association. The results also demonstrate that some centres defined as HVRFs were undertaking very few procedures per annum (< 5 radiotherapy cases/year).