1. Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.
- Author
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Heilbroner SP, Xanthopoulos EP, Buono D, Carrier D, Durkee BY, Corradetti M, Wang TJC, Neugut AI, Hershman DL, and Cheng SK
- Subjects
- Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Non-Small-Cell Lung radiotherapy, Cohort Studies, Female, Humans, Logistic Models, Lung Neoplasms mortality, Lung Neoplasms pathology, Lung Neoplasms radiotherapy, Male, Neoplasm Staging, Propensity Score, Radiotherapy, Image-Guided methods, Radiotherapy, Intensity-Modulated methods, Survival Analysis, Treatment Outcome, Carcinoma, Non-Small-Cell Lung economics, Cost-Benefit Analysis, Lung Neoplasms economics, Radiotherapy, Image-Guided economics, Radiotherapy, Intensity-Modulated economics
- Abstract
Background: High-frequency image-guided radiotherapy (hfIGRT) is ubiquitous but its benefits are unproven. We examined the cost effectiveness of hfIGRT in stage III non-small-cell lung cancer (NSCLC)., Methods: We selected stage III NSCLC patients ≥66 years old who received definitive radiation therapy from the Surveillance, Epidemiology, and End-Results-Medicare database. Patients were stratified by use of hfIGRT using Medicare claims. Predictors for hfIGRT were calculated using a logistic model. The impact of hfIGRT on lung toxicity free survival (LTFS), esophageal toxicity free survival (ETFS), cancer-specific survival (CSS), overall survival (OS), and cost of treatment was calculated using Cox regressions, propensity score matching, and bootstrap methods., Results: Of the 4,430 patients in our cohort, 963 (22%) received hfIGRT and 3,468 (78%) did not. By 2011, 49% of patients were receiving hfIGRT. Predictors of hfIGRT use included treatment with intensity-modulated radiotherapy (IMRT) (OR = 7.5, p < 0.01), recent diagnosis (OR = 51 in 2011 versus 2006, p < 0.01), and residence in regions where the Medicare intermediary allowed IMRT (OR = 1.50, p < 0.01). hfIGRT had no impact on LTFS (HR 0.97; 95% CI 0.86-1.09), ETFS (HR 1.05; 95% CI 0.93-1.18), CSS (HR 0.94; 95% CI 0.84-1.04), or OS (HR 0.95; 95% CI 0.87-1.04). Mean radiotherapy and total medical costs six months after diagnosis were $17,330 versus $15,024 (p < 0.01) and $71,569 versus $69,693 (p = 0.49), respectively., Conclusion: hfIGRT did not affect clinical outcomes in elderly patients with stage III NSCLC but did increase radiation cost. hfIGRT deserves further scrutiny through a randomized controlled trial., Competing Interests: Dr. Wang reports personal fees and non-financial support from AbbVie, non-financial support from Merck, personal fees from AstraZeneca, personal fees from Doximity, personal fees and non-financial support from Novocure, personal fees and nonfinancial support from Elekta and personal fees from Wolters Kluwer, outside the submitted work; Dr. Cheng reports consulting fees from AbbVie. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors have no conflicts of interest.
- Published
- 2021
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