Updating the Malthus Programme decision tree for nonsmall cell lung cancer
Sundaram, S. Heritage, S. Mee, Thomas Kirkby, Norman Jena, R. Kirkby, Karen J
Sundaram, S.
Heritage, S.
Mee, Thomas
Kirkby, Norman
Jena, R.
Kirkby, Karen J
Citations
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Abstract
Introduction: The Malthus Programme models radiotherapy
demand by combining data on cancer incidence with clinical
decision trees detailing indications and dose-fractionation for radiotherapy. Since the last model update in 2017, we observe widespread
implementation of hypofractionated stereotactic ablative radiotherapy (SABR) and a trend towards more aggressive treatment
of patients with oligometastatic disease. We assess the impact of
recent changes in clinical practice on radiotherapy demand for non-small cell lung cancer (NSCLC) across England in the latest model.
Methods: The NSCLC decision tree was updated based on evidence
for new radiotherapy indications and dose-fractionation schedules,
as well as estimates of stage distribution and relative use of
alternative management options. These were derived from literature
searches, relevant guidelines, discussion with clinical oncologists,
public databases and National Lung Cancer Audit data.
Results: The main updates to NSCLC radiotherapy practice
have been the implementation of SABR for early-stage disease,
increasing utilisation of surgery, and radical thoracic radiotherapy
treatment for patients with cerebral oligometastatic disease. The
proportion of NSCLC patients receiving radiotherapy (appropriate
rate of radiotherapy: ARR) decreased by 3% since the 2017 model.
This was principally due to an increase in surgery as opposed to
definitive radiotherapy for Stage III disease. The overall decrease in
ARR masks the extra patients with Stage IV disease now receiving
radical radiotherapy. Fraction burden decreased by 15%, reflecting
both the reduced ARR and increasingly hypofractionated schedules,
particularly for early-stage NSCLC.
Conclusions: Use of SABR for early-stage NSCLC, combined with
increasing resection rates for Stage III disease, seem to have reduced
fraction demand. However, our estimate of rise in resection rate
may have been affected by the lack of national audit data available
to inform our original model. Future fraction burden may change as early detection fuels demand for SABR, and more indications for
radiotherapy for oligometastatic disease emerge.
Description
Date
2022
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Sundaram S, Heritage S, Mee T, Kirkby K, Kirkby N, Jena R. Updating the Malthus Programme decision tree for non-small cell lung cancer. Vol. 165, Lung Cancer. Elsevier BV; 2022. p. S55.