Estimation of optimal brachytherapy utilization rate in the treatment of malignancies of the uterine corpus by a review of clinical practice guidelines and the primary evidence.
OBJECTIVE
Brachytherapy (BT) is an important treatment technique for uterine corpus malignancies. We modeled the optimal proportion of these cases that should be treated with BT-the optimal rate of brachytherapy utilization (BTU). We compared this optimal BTU rate with the actual BTU rate.


METHODS
Evidence-based guidelines and the primary evidence were used to construct a decision tree for BTU for malignancies of the uterine corpus. Searches of the literature to ascertain the proportion of patients who fulfilled the criteria for BT were conducted. The robustness of the model was tested by sensitivity analyses and peer review. A retrospective Patterns of Care Study of BT in New South Wales for 2003 was conducted, and the actual BTU for uterine corpus malignancies was determined. The actual BTU in other geographic areas was calculated from published reports. The differences between the optimal and actual rates of BTU were assessed.


RESULTS
The optimal uterine corpus BTU rate was estimated to be 40% (range, 36-49%). In New South Wales in 2003, the actual BTU rate was only 14% of the 545 patients with uterine corpus cancer. The actual BTU rate in 2001 was 11% in the Surveillance, Epidemiology, and End Results areas and 30% in Sweden.


CONCLUSIONS
The results of this study have shown that BT for uterine corpus malignancies is underused in New South Wales and in the Surveillance, Epidemiology, and End Results areas. Our model of optimal BTU can be used as a quality assurance tool, providing an evidence-based benchmark against which can be measured actual patterns of practice. It can also be used to assist in determining the adequacy of BT resource allocation.
Thompson
Stephen R
SR
Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, NSW, Australia.
Delaney
Geoff
G
Gabriel
Gabriel S
GS
Jacob
Susannah
S
Das
Prabir
P
Barton
Michael
M
D001918:Brachytherapy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy; D003663:Decision Trees; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging; D009367:Neoplasm Staging; D009517:New South Wales; D017410:Practice Guidelines as Topic; D011859:Radiography; D011879:Radiotherapy Dosage; D014594:Uterine Neoplasms / Q000473:pathology / Q000532:radiotherapy*