Original Title: Nuevas técnicas IMRT para dianas en movimiento. Análisis de su seguridad y efectividad

Authors' objectives: – To assess the safety, efficacy and therapeutic indications for intensity-modulated radiotherapy (IMRT) techniques for moving targets. - To assess the clinical utility of new IMRT techniques for moving targets in the cancer treatment process and its effects on mean disease-free survival and the appearance of comorbidities associated with radiotherapy use in comparison with conventional techniques.

Authors' results and conclusions: There are currently three devices that allow intrafraction image guided radiography, two of these (Calypso 4D and AlignRT) have been approved by the FDA for the American market and one (RayPilot®) has received CE marking for use in Europe. No systematic reviews or health technology assessment reports concerning the subject of this study were found. A single clinical practice guideline included in the National Guidelines Clearing House and produced by the American College of Radiologists and a CPG from the National Comprehensive Cancer Network (NCCN) were found. The local and regional directives found did not include this technique amongst their reimbursement recommendations or included it as a technique under study and research. No primary controlled and randomised studies were found. Three comparative, controlled but non-randomised studies and two case series with more than 30 patients were found. The studies found use surrogate results variables. Said studies conclude that there are differences as regards the target site and volume, although no significant differences were found for the treatment as a whole. Prospective, controlled and randomised studies which compare interfraction planning with respect to intrafraction image-guided radiography and use morbi-mortality and quality of life as final results variables should be performed. Until the differential efficacy of this technique with respect to currently used techniques is demonstrated, it should not be considered for standard use.

Authors' methods: A systematic literature review, including clinical practice guidelines (CPGs) and directives. The databases used were: Medline, EMBASE, NGC, DARE, NHS-EED, INAHTA, GuiaSalud and the Cochrane Database of Systematic Reviews. To extract the evidence from CPGs and directives, a literature search of secondary evidence (CPGs, health technology assessment reports, systematic reviews and meta-analyses) concerning intrafraction image-guided treatment was performed. The inclusion criteria were documents concerning radiotherapy treatment with intrafraction image-guided diagnosis published after 2007 in the case of CPGs and directives (5 years due to obsolescence). AGREE II was used to assess the quality of CPGs, whereas the FLC critical reading software was used for individual studies, systematic reviews and meta-analyses. Quality was assessed by two assessors independently. Drafting of clinical practice recommendations and reimbursement.

Project Status: Completed

Year Published: 2014

URL for published report: https://www.euskadi.eus/contenidos/informacion/2014_osteba_publicacion/es_def/adjuntos/IMRTdianas.pdf

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government