ESTRO 2024 - Abstract Book

S140

Invited Speaker

ESTRO 2024

The target: Who needs what?

In radiotherapy for localized prostate cancer, the chances of cure are determined by local control of the prostatic tumour and the presence of subclinical distant metastasis at time of treatment. If a tumour has already spread outside of the prostate at time of treatment, the disease will probably not be cured by radiotherapy alone. In the recent years, detection of subclinical distant disease has improved immensely, with new imaging techniques such as PSMA PETCT, making the importance of local tumour control even more eminent. There is a dose-effect relationship for local tumour control, more is better. However, due to the proximity of the organs-at-risk, such as bladder and rectum, further dose escalation to the whole prostate gland without an increase in toxicity is challenging. Traditionally, the radiotherapy treatment for localized prostate cancer consideres the whole prostatic gland to be the main target for irradiation. The FLAME trial demonstrated that dose escalation to the visible tumour (GTV), instead of the whole organ, significantly improves the 5-year biochemical disease-free survival without any additional toxicity. This was achieved by prioritizing the organs-at-risk constraints over the focal GTV boost dose which resulted in a reduced GTV dose in the focal boost arm if necessary. Analysis of the FLAME data led to insights that can help to further improve radiotherapy for localized prostate cancer. Which patients do fail and why do they fail? Is there a dose-effect relationship? If yes, what GTV dose should preferably be achieved? Is it the maximum, mean or the minimum dose that is relevant? Also, the location and dosimetry of intra-prostatic recurrences will be discussed. Do intra-prostatic recurrences originate from outside of the high-dose GTV treated with a regular dose or rather from an undertreated GTV. The latter could be a consequence of very radio insensitive tumours that recur even when treated with high-dose or the cases where high focal boost dose was not reached.

3606

The economist, for efficiency and care improvement

Alexander Fabian

University Hospital Schleswig-Holstein, Department of Radiotherapy, Kiel, Germany

Abstract:

Radiation Oncology (RO) is characterized by rapidly evolving techniques and innovative treatments, challenging outcome measurement, complex costing and reimbursement, as well as operator and workforce dependence, and delicate clinical decision making. Health Economists strive to handle such challenges in health care through various approaches. First, classic health technology assessment examines ratios of benefits and costs of interventions from the payer’s or society’s perspective. More recently, value-based frameworks aim to strengthen these assessments by emphasizing the degree of evidence and patient-centeredness of potential benefits. Further, the patient’s perspective has gained attention also in health economy for example assessing financial toxicity of cancer treatment.Second, costing is vital yet challenging in RO and requires detailed knowledge of RO processes driving costs rather than consumables. Time-based activity based costing models have been developed to capture expenses in RO more accurately. These informations are essential to negotiate sustainable reimbursements. Third, Health Economists may pave the way for innovations in RO by offering frameworks to evaluate and establishing models to fund innovations. Fourth, management and soft skills inspired by economists may benefit RO for example to recruit and retain scarce workforce or to raise awareness of cognitive biases in clinical decision making. Hence, RO has already and should further benefit from the broad scope of health economics. Specialists trained in RO should embrace and support economic analyses to maximize their impact on efficiency and care improvement.