Estimation of an optimal radiotherapy utilization rate for gastrointestinal carcinoma

A review of the evidence

Authors

  • Geoff Delaney M.B.B.S., M.D.,

    Corresponding author
    1. Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, Australia
    • Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Locked Bag 7103, Liverpool, New South Wales, 1871, Australia
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    • Fax: (011) 61 298285299

  • Michael Barton M.B.B.S.,

    1. Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, Australia
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  • Susannah Jacob M.B.B.S., M.D.

    1. Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, Australia
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Abstract

BACKGROUND

Radiotherapy utilization rates for cancer vary widely, both within and between countries. The optimal proportion of patients with gastrointestinal malignancies who should receive at least one course of radiotherapy at some time during their illness is an important benchmark.

METHODS

The authors studied treatment guidelines and treatment reviews to identify the indications for radiotherapy for patients with gastrointestinal malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes of patients with gastrointestinal carcinomas who will benefit from radiotherapy. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with gastrointestinal malignancies for whom radiotherapy was considered appropriate. Optimal rates of radiotherapy use were compared with actual rates in population-based studies to assess any discrepancies between actual and optimal radiotherapy utilization rates.

RESULTS

Radiotherapy was indicated in 80% of patients with esophageal carcinoma, 68% of patients with gastric carcinoma, 57% of patients with pancreatic carcinoma, 13% of patients with carcinoma of the gallbladder, 0% of patients with hepatic carcinoma, 14% of patients with colon carcinoma, and 61% of patients with rectal carcinoma. The actual radiotherapy utilization rates for most of these gastrointestinal malignancies fell well short of optimal rates, which were derived from evidence-based treatment guidelines.

CONCLUSIONS

It is possible to model optimal radiotherapy utilization using published treatment guidelines and existing incidence data. There was a discrepancy between the optimal and actual rates of radiotherapy utilization for patients with carcinomas of the esophagus, stomach, pancreas, and rectum. Strategies to implement evidence-based clinical guidelines are recommended. Cancer 2004. © 2004 American Cancer Society.

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