Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.

<h4>Background</h4>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).<h4>Methods</h4>We selected stage III NSCLC patients ≥66 years old wh...

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Autores principales:	Samuel P Heilbroner, Eric P Xanthopoulos, Donna Buono, Daniel Carrier, Ben Y Durkee, Michael Corradetti, Tony J C Wang, Alfred I Neugut, Dawn L Hershman, Simon K Cheng
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a119368c9c4c4b05909411626be4498b
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spelling	oai:doaj.org-article:a119368c9c4c4b05909411626be4498b2021-11-25T06:23:43ZEfficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.1932-620310.1371/journal.pone.0252053https://doaj.org/article/a119368c9c4c4b05909411626be4498b2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252053https://doaj.org/toc/1932-6203<h4>Background</h4>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).<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Samuel P HeilbronerEric P XanthopoulosDonna BuonoDaniel CarrierBen Y DurkeeMichael CorradettiTony J C WangAlfred I NeugutDawn L HershmanSimon K ChengPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0252053 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Samuel P Heilbroner Eric P Xanthopoulos Donna Buono Daniel Carrier Ben Y Durkee Michael Corradetti Tony J C Wang Alfred I Neugut Dawn L Hershman Simon K Cheng Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.
description	<h4>Background</h4>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).<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
format	article
author	Samuel P Heilbroner Eric P Xanthopoulos Donna Buono Daniel Carrier Ben Y Durkee Michael Corradetti Tony J C Wang Alfred I Neugut Dawn L Hershman Simon K Cheng
author_facet	Samuel P Heilbroner Eric P Xanthopoulos Donna Buono Daniel Carrier Ben Y Durkee Michael Corradetti Tony J C Wang Alfred I Neugut Dawn L Hershman Simon K Cheng
author_sort	Samuel P Heilbroner
title	Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.
title_short	Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.
title_full	Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.
title_fullStr	Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.
title_full_unstemmed	Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.
title_sort	efficacy and cost of high-frequency igrt in elderly stage iii non-small-cell lung cancer patients.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a119368c9c4c4b05909411626be4498b
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Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients.

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