Original Title: Evaluación de radioterapia conformada con haces de intensidad modulada. IMRT

Authors' objectives: 1. To assess the safety, efficacy and therapeutic indications for intensity-modulated radiotherapy (IMRT) and compare them with the various conventional radiotherapy techniques or with 3D conformal radiotherapy. 2. To assess the clinical utility of IMRT in the cáncer treatment process and its effects on mean disease-free survival and the appearance of comorbidities associated with radiotherapy use. 3. To determine the incidence of cáncerous diseases that can be treated using IMRT. 4. To determine the international guidelines concerning human and material resources needs, minimum stoppage times, planning time, dose, mean number of sessions per patient and indication. 5. To analyse the possible economic and health system organisational repercussions that may arise upon widespread implementation of IMRT. To analyse the individual costs of IMRT implementation and compare the cost differences between the IMRt and 3D CRT techniques. To analyse the procedure cost per patient of IMRT and 3D CRT for breast and prostate cancer.

Authors' results and conclusions: The studies retrieved are, in general, of moderate to poor quality. This does not allow the efficacy of the technique to be accurately determined. In general, the studies are observational prospective studies with populations that are difficult to compare as they are based on different initial prognoses. However, these studies appear to show that the technique is safe, as no more episodes of major complications are reported in comparison with conventional therapies and a lower comparative morbidity is detected. The improvements resulting from the technique arise due to the better risk/benefit ratio rather than by an improved final health outcome (except for quality of life, which clearly improves), which are similar to those for other, more conventional techniques in all studies retrieved. There is no evidence to support the use of this technique for the following anatomical locations: colon/rectum, gynaecological sites, skin, thyroid, soft-tissue sarcomas and lung (except for non-small cell lung cáncer) There is no evidence comparing the costs of the different treatments against each other. This should be compared in terms of the cost-effectiveness of the various therapeutic alternatives. Two anatomical locations for which evidence of utility exists, namely breast and prostate, were compared. The cost of implementing this technique is similar for both locations. The cost of the procedure per patient for IMRt for the breast cáncer location represents a 122% cost increase with respect to 3D CRT. In contrast, the increase for prostate cáncer is 228%. This higher increase for prostate cáncer is due to the radiophysical requirements during quality control. The difference with respect to 3D-CRT at both locations can mainly be explained by the number of patients treated per year and per machine using each technique. It is possible that increased automation of the procedures could allow higher activity and therefore lead to a cost reduction. Analysis is currently more difficult due to the appearance of new techniques that are better than current ones as a result of the dynamism of this sector.

Authors' methods: For objectives 1, 2 and 3: A literature review was performed to evaluate the efficacy and safety of the IMRT technique. For objective 4: To determine the international guidelines for radiotherapy, and specifically IMRT, a search was performed on the web pages of the societies AERO, ASTRO, ESGO, ESTRO, IARC and ISRO. Finally, for objective 5: To analyse the possible economic and health system organisational repercussions that may arise upon widespread implementation of this technique, a literature search of the evidence and a cost analysis, in which the data extracted from a survey were used together with a consultation with experts and suppliers to determine the key process in the cost analysis and the economic influence of each technique and by anatomical location of the tumour, were performed Two locations, namely breast and prostate, were analysed and compared.

Project Status: Completed

Year Published: 2014

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

English language abstract: An English language summary is available

Publication Type: Full 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