ESTRO 2024 - Abstract Book

S2829

Interdisciplinary - Health economics & health services research

ESTRO 2024

Forty-two external beam radiotherapy indications were considered ( Table 1 : 31 curative, 11 palliative). Real-world data was the highest level of evidence available to evaluate 11 treatment indications. Twenty-five of 30 curative radiotherapy benefits comparing radiotherapy to no radiotherapy scored A (83%), the highest level of benefit for curative treatments in MCBS ( Table 1 ). All curative indications scored A or B, considered ‘substantial benefit’ by MCBS criteria. For breast cancer, two curative indications were scored A, and three B. For lung cancer, seven curative indications were scored A and two B. All curative indications scored A for cervical cancer (N=7) and prostate cancer (N=9). Notably, curative indications for prostate cancer could not be evaluated unless biochemical control was equated with progression-free survival. For palliative indications comparing radiotherapy to no radiotherapy, scores varied, with three scored 5 (highest MCBS score in the palliative setting), two scored 3-4, and two scored 1-2 ( Table 1 ). There were five indications comparing two forms of radiotherapy. The one curative indication scored A (stereotactic ablative body radiotherapy versus conventional radiotherapy for stage I non-small cell lung cancer (NSCLC)). The four palliative indications scored 3-4 (short course vs long course uncomplicated bone metastasis and NSCLC thoracic radiation, stereotactic body radiotherapy vs conventional radiotherapy for painful spinal metastasis, stereotactic radiotherapy (SRS) alone vs SRS plus whole brain radiotherapy for 1-4 brain metastases). Curative radiotherapy indications scored highly according to the MCBS scale, while palliative indication scores varied. Net new investment in radiotherapy is of substantial benefit in this pilot study, demonstrated by the high scores for radiotherapy vs no radiotherapy indications. This is relevant to the investment case for scale up of radiotherapy globally. In comparisons of two forms of radiotherapy, the scenario most often faced in established radiotherapy programs, the MCBS score varied, emphasizing the importance of clinical research to accurately define the magnitude of benefit, and value. Observations during this pilot study highlighted that radiotherapy benefit scoring requires clear direction on the use of pooled data, and real-world evidence. It should be patient centered and consider radiotherapy-related endpoints such as local control and biochemical control not present in MCBS. Therefore, defining radiotherapy value requires unique considerations compared to systemic therapy, and a benefit scale that encompasses a broad range of data sources. Conclusion:

Table 1: Summary of MCBS Scoring for Radiotherapy Indications

Number

of

Indications

Greatest Benefit: MCBS Score A or 5-4

Least Benefit: MCBS Score C or 1 2

MCBS Score B or 3

Indication type

Curative

indications:

Radiotherapy

vs

No

25

5

0

radiotherapy

Breast cancer curative radiotherapy indications

2

3

0

Lung cancer curative radiotherapy indications

7

2

0

Cervical cancer curative radiotherapy indications

7

0

0

Prostate cancer curative radiotherapy indications

9

0

0

Palliative

indications:

Radiotherapy

vs

No

3

2

2

radiotherapy

Curative indications: Two forms of radiotherapy compared 1

0

0