The population benefit of radiotherapy for cervical cancer: local control and survival estimates for optimally utilized radiotherapy and chemoradiation.
OBJECTIVE
Population benefits of radiotherapy if evidence-based guidelines were routinely followed across the entire population are largely unknown. The aim of this study was to investigate population-based benefits for cervical cancer.


METHODS
Overall survival (OS) and local control (LC) benefits were investigated. XRT benefit was defined as the absolute benefit of radiotherapy, over no treatment, for radical indications and defined as the benefit of adjuvant radiation over surgery alone for adjuvant indications. The concurrent chemoradiation (CRT) benefit was the incremental benefit of CRT over XRT. Australian population benefits were modeled using decision trees. Citation databases were systematically queried. Meta-analysis was performed if multiple sources of the same evidence level existed. Robustness of the model assumptions was tested through sensitivity analysis.


RESULTS
53% of all cervix patients had adjuvant or curative radiotherapy indications. 96% were for CRT. The estimated 5-year absolute benefits of optimally utilized radiotherapy alone were: LC: 31% (95% Confidence Interval 29%, 34%), OS: 17% (15%, 18%). These were over and above the contribution of other modalities to outcomes. The incremental 5-year absolute benefits of CRT were: LC 4% (2%, 5%), OS 3% (1%, 5%). In sensitivity analysis, the model was robust.


CONCLUSIONS
Optimally utilized radiotherapy provides substantial population OS and LC benefits for cervical cancer. Chemoradiation provides a modest population benefit over XRT. The population-based model was robust.
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute, University of New South Wales, Liverpool, Australia. Electronic address: thanna@kgh.kari.net.
T P
TP
Hanna
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute, University of New South Wales, Liverpool, Australia.
J
J
Shafiq
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute, University of New South Wales, Liverpool, Australia.
G P
GP
Delaney
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute, University of New South Wales, Liverpool, Australia.
M B
MB
Barton
D001315:Australia; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
Cervical cancer; Chemoradiation; Demand model; Effectiveness; Population benefit; Radiotherapy