Estimating the optimal utilization rates of radiotherapy for hematologic malignancies from a review of the evidence: part I-lymphoma.
BACKGROUND
The objective of this study was to estimate the ideal proportion of new patients with lymphoma who should receive radiotherapy at some time during the course of their illness, based on the best evidence.


METHODS
Available evidence of the efficacy of radiotherapy in most clinical situations for lymphoma were identified through extensive literature reviews and treatment guideline searches. Epidemiologic data concerning the distribution of histologic type, disease stage, and other factors that influence the use of radiotherapy were identified. Decision trees were constructed to merge the evidence-based recommendations with the epidemiologic data to calculate the optimal proportion of patients who should receive radiotherapy according to the best available evidence. Actual radiotherapy utilization rates also were identified.


RESULTS
The proportion of patients with lymphoma in Australia that should receive radiotherapy at some point in their management, according to the best available evidence, was calculated at 65.0%. Multivariate analysis with a Monte Carlo simulation yielded a radiotherapy utilization rate of 64.4%. The actual utilization rates of radiotherapy for lymphoma reported in clinical practice were 22-29%, substantially lower than the optimal rate calculated in this project.


CONCLUSIONS
Further research will be required to identify why more patients who are diagnosed with lymphoma are not treated with radiotherapy.
Featherstone
Carolyn
C
Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, New South Wales, Australia. carrie.featherstone@northglasgow.scot.nhs.uk
Delaney
Geoff
G
Jacob
Susannah
S
Barton
Michael
M
D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D019317:Evidence-Based Medicine; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009367:Neoplasm Staging; D018579:Patient Selection; D010380:Peer Review; D011379:Prognosis; D018787:Radiation Oncology; D011878:Radiotherapy / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome