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The cost-effectiveness and cost-utility of high-dose palliative radiotherapy for advanced non-small-cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature196688
Source
Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):1025-33
Publication Type
Article
Date
Nov-1-2000
Author
P. Coy
J. Schaafsma
J A Schofield
Author Affiliation
Vancouver Island Cancer Centre, British Columbia Cancer Agency, Victoria, BC, Canada.
Source
Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):1025-33
Date
Nov-1-2000
Language
English
Publication Type
Article
Keywords
British Columbia
Carcinoma, Non-Small-Cell Lung - mortality - pathology - radiotherapy
Cost of Illness
Cost-Benefit Analysis
Humans
Lung Neoplasms - mortality - pathology - radiotherapy
Multivariate Analysis
Neoplasm Staging
Palliative Care - economics
Prospective Studies
Quality-Adjusted Life Years
Radiotherapy - economics
Abstract
To compute cost-effectiveness/cost-utility (CE/CU) ratios, from the treatment clinic and societal perspectives, for high-dose palliative radiotherapy treatment (RT) for advanced non-small-cell lung cancer (NSCLC) against best supportive care (BSC) as comparator, and thereby demonstrate a method for computing CE/CU ratios when randomized clinical trial (RCT) data cannot be generated.
Unit cost estimates based on an earlier reported 1989-90 analysis of treatment costs at the Vancouver Island Cancer Centre, Victoria, British Columbia, Canada, are updated to 1997-1998 and then used to compute the incremental cost of an average dose of high-dose palliative RT. The incremental number of life days and quality-adjusted life days (QALDs) attributable to treatment are from earlier reported regression analyses of the survival and quality-of-life data from patients who enrolled prospectively in a lung cancer management cost-effectiveness study at the clinic over a 2-year period from 1990 to 1992.
The baseline CE and CU ratios are $9245 Cdn per life year (LY) and $12,836 per quality-adjusted life year (QALY), respectively, from the clinic perspective; and $12,253/LY and $17,012/QALY, respectively, from the societal perspective. Multivariate sensitivity analysis for the CE ratio produces a range of $5513-28,270/LY from the clinic perspective, and $7307-37,465/LY from the societal perspective. Similar calculations for the CU ratio produce a range of $7205-37, 134/QALY from the clinic perspective, and $9550-49,213/QALY from the societal perspective.
The cost effectiveness and cost utility of high-dose palliative RT for advanced NSCLC compares favorably with the cost effectiveness of other forms of treatment for NSCLC, of treatments of other forms of cancer, and of many other commonly used medical interventions; and lies within the US $50, 000/QALY benchmark often cited for cost-effective care.
PubMed ID
11072159 View in PubMed
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[Curative radiotherapy of local advanced non-small-cell lung cancer. Eight years of experience from Odense]

https://arctichealth.org/en/permalink/ahliterature16768
Source
Ugeskr Laeger. 2005 Sep 12;167(37):3497-502
Publication Type
Article
Date
Sep-12-2005
Author
Olfred Hansen
Helene Paarup
Peter Sørensen
Karin Holmskov Hansen
Knud Aage Werenberg
Author Affiliation
Onkologisk Afdeling R, Odense Universitetshospital, Odense C. olfred@dadlnet.dk
Source
Ugeskr Laeger. 2005 Sep 12;167(37):3497-502
Date
Sep-12-2005
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Carcinoma, Non-Small-Cell Lung - mortality - pathology - radiotherapy
Chemotherapy, Adjuvant
Denmark - epidemiology
English Abstract
Female
Humans
Lung Neoplasms - mortality - radiotherapy
Male
Middle Aged
Neoplasm Staging
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Conformal - adverse effects - methods
Survival Rate
Abstract
INTRODUCTION: No previous reports on 3-D conformal radiotherapy of Danish patients with inoperable local advanced non-small-cell lung cancer have been published. MATERIALS AND METHODS: From 1995 to 2003, 158 patients with inoperable non-small-cell stage III lung cancer received radical radiotherapy in doses of 60-66 Gy in 30-33 fractions. Neoadjuvant chemotherapy was administered to 77 patients. RESULTS: The median survival time was 15.8 months. The one, two-, three-, four-, and five-year survival rates were 61%, 35%, 23%, 19% and 17%, respectively. Gender and age had no influence on survival, while patients in performance status 2 tended to have poorer survival rate than patients in performance status 0-1. The lung function as evaluated byh FEV1 and FVC declined by 8-9% during the first year and was reduced by 9-13% after three years. The cause of death in 90% of the cases was lung cancer. In 50% of all cases, a loco-regional relapse was found, and in 41% distant metastases existed. DISCUSSION: These results show that a significant number of stage III patients treated with modern radiotherapy with curative intent will be long-term survivors.
PubMed ID
16159459 View in PubMed
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Pattern of loco-regional failure after definitive radiotherapy for non-small cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature257607
Source
Acta Oncol. 2014 Mar;53(3):336-41
Publication Type
Article
Date
Mar-2014
Author
Tine Schytte
Tine Bjørn Nielsen
Carsten Brink
Olfred Hansen
Author Affiliation
Department of Oncology, Odense University Hospital , Odense , Denmark.
Source
Acta Oncol. 2014 Mar;53(3):336-41
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung - mortality - pathology - radiotherapy
Denmark
Female
Humans
Kaplan-Meier Estimate
Lung Neoplasms - mortality - pathology - radiotherapy
Lymph Nodes - pathology
Male
Middle Aged
Radiotherapy Dosage
Treatment Failure
Treatment Outcome
Tumor Burden
Abstract
Non-small cell lung cancer (NSCLC) is associated with poor survival even though patients are treated with curatively intended radiotherapy. Survival is affected negatively by lack of loco-regional tumour control, but survival is also influenced by comorbidity caused by age and smoking, and occurrence of distant metastasis. It is challenging to evaluate loco-regional control after definitive radiotherapy for NSCLC since it is difficult to distinguish between radiation-induced damage to the lung tissue and tumour progression/recurrence. In addition it may be useful to distinguish between intrapulmonary failure and mediastinal failure to be able to optimize radiotherapy in order to improve loco-regional control even though it is not easy to discriminate between the two sites of failure.
This study is a retrospective analysis of 331 NSCLC patients treated with definitive radiotherapy from 2002 to 2011. The patients were treated consecutively at the Department of Oncology, Odense University Hospital, Denmark with at least 60 Gy. All patients were followed in a planned follow-up schedule and no patients were lost for follow-up.
At the time of the analysis 93 patients had loco-regional failure only. Of these patients, 68 had intrapulmonary failure only, one patient had failure in mediastinum only, and 24 patients had intrapulmonary failure as well as mediastinal failure. Of the patients which had lung failure only, 78% had mediastinal involvement at treatment start. The only covariate with significant impact on developing intrapulmonary failure only was gross tumour volume. Median survival for the total group of 331 patients was 19 months. The median survival for patients with intrapulmonary failure only was 19 months, and it was 20 months for the patients with mediastinal relapse.
We conclude that focus should be on increasing doses to intrapulmonary tumour volume, when dose escalation is applied to improve local tumour control in NSCLC patients treated with definitive radiotherapy, since most recurrences are located here.
PubMed ID
24369735 View in PubMed
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Swedish Lung Cancer Radiation Study Group: predictive value of age at diagnosis for radiotherapy response in patients with non-small cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature122642
Source
Acta Oncol. 2012 Jul;51(6):759-67
Publication Type
Article
Date
Jul-2012
Author
Georg Holgersson
Even Hoye
Michael Bergqvist
Simon Ekman
Jan Nyman
Martin Helsing
Signe Friesland
Margareta Holgersson
Lars Ekberg
Thomas Blystad
Sven-Börje Ewers
Charlotte Mörth
Britta Löden
Roger Henriksson
Stefan Bergström
Author Affiliation
Department of Oncology, Uppsala University Hospital, Sweden. georg.h@telia.com
Source
Acta Oncol. 2012 Jul;51(6):759-67
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - mortality - pathology - radiotherapy
Adult
Age Factors
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung - mortality - pathology - radiotherapy
Carcinoma, Squamous Cell - mortality - pathology - radiotherapy
Female
Humans
Lung Neoplasms - mortality - pathology - radiotherapy
Male
Middle Aged
Neoplasm Staging
Prognosis
Retrospective Studies
Survival Rate
Sweden
Abstract
The aim of the present study was to investigate the impact of age at diagnosis on prognosis in patients treated with curatively intended radiotherapy for NSCLC.
This is a joint effort among all the Swedish Oncology Departments that includes all identified patients with a diagnosed non-small cell lung cancer that have been subjected to curatively intended irradiation (=50 Gy) treated during 1990 to 2000. Included patients had a histopathological/cytological diagnosis date as well as a death date or a last follow-up date. The following variables were studied in relation to overall and disease-specific survival: age, gender, histopathology, time period, smoking status, stage and treatment.
The median overall survival of all 1146 included patients was 14.7 months, while the five-year overall survival rate was 9.5%. Younger patients (
PubMed ID
22793039 View in PubMed
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Swedish lung cancer radiation study group: predictive value of histology for radiotherapy response in patients with non-small cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature133224
Source
Eur J Cancer. 2011 Nov;47(16):2415-21
Publication Type
Article
Date
Nov-2011
Author
Georg Holgersson
Stefan Bergström
Michael Bergqvist
Jan Nyman
Even Hoye
Martin Helsing
Signe Friesland
Margareta Holgersson
Elisabet Birath
Simon Ekman
Thomas Blystad
Sven-Börje Ewers
Charlotte Mörth
Britta Löden
Roger Henriksson
Author Affiliation
Department of Oncology, Uppsala University Hospital, Sweden.
Source
Eur J Cancer. 2011 Nov;47(16):2415-21
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - mortality - pathology - radiotherapy
Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung - mortality - pathology - radiotherapy
Carcinoma, Squamous Cell - mortality - pathology - radiotherapy
Female
Humans
Lung Neoplasms - mortality - pathology - radiotherapy
Male
Middle Aged
Neoplasm Staging
Predictive value of tests
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Sweden
Abstract
The aim of the present study was to evaluate the potential predictive value of histology in non-small cell lung cancer (NSCLC) treated with curatively intended radiotherapy. In a collaborative effort among all the Swedish Oncology Departments, clinical data were collected for 1146 patients with a diagnosed non-small cell lung cancer subjected to curatively intended irradiation (?50 Gy) during the years 1990 to 2000. The included patients were identified based on a manual search of all medical and radiation charts at the oncology departments from which the individual patient data were collected. Only patients who did not have a histological diagnosis date and death date/last follow-up date were excluded (n=141). Among the 1146 patients with non-small cell carcinoma eligible for analysis, 919 were diagnosed with either adenocarcinoma (n=323) or squamous cell carcinoma (n=596) and included in this study. The median survival for the 919 patients was 14.8 months, while the 5-year survival rate was 9.5%. Patients with adenocarcinoma had a significantly better overall survival compared with patients with squamous cell carcinoma (p=0.0062, log-rank test). When comparing different stages, this survival benefit was most pronounced for stages IIA-IIB (p
PubMed ID
21726999 View in PubMed
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