Bayesian methods provide a practical real-world evidence framework for evaluating the impact of changes in radiotherapy
O'Connor, James P B
Price, Gareth J
AffiliationDivision of Cancer Sciences, University of Manchester, Manchester, UK
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AbstractPurpose: Retrospective studies have identified a link between the average set-up error of lung cancer patients treated with image-guided radiotherapy (IGRT) and survival. The IGRT protocol was subsequently changed to reduce the action threshold. In this study, we use a Bayesian approach to evaluate the clinical impact of this change to practice using routine 'real-world' patient data. Methods and materials: Two cohorts of NSCLC patients treated with IGRT were compared: pre-protocol change (N = 780, 5 mm action threshold) and post-protocol change (N = 411, 2 mm action threshold). Survival models were fitted to each cohort and changes in the hazard ratios (HR) associated with residual set-up errors was assessed. The influence of using an uninformative and a skeptical prior in the model was investigated. Results: Following the reduction of the action threshold, the HR for residual set-up error towards the heart was reduced by up to 10%. Median patient survival increased for patients with set-up errors towards the heart, and remained similar for patients with set-up errors away from the heart. Depending on the prior used, a residual hazard ratio may remain. Conclusions: Our analysis found a reduced hazard of death and increased survival for patients with residual set-up errors towards versus away from the heart post-protocol change. This study demonstrates the value of a Bayesian approach in the assessment of technical changes in radiotherapy practice and supports the consideration of adopting this approach in further prospective evaluations of changes to clinical practice.
CitationFornacon-Wood I, Mistry H, Johnson-Hart C, Faivre-Finn C, O'Connor JPB, Price GJ. Bayesian methods provide a practical real-world evidence framework for evaluating the impact of changes in radiotherapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2022 Sep 20;176:53-8. PubMed PMID: 36184998. Epub 2022/10/04. eng.
JournalRadiotherapy and Oncology
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