Bayesian methods provide a practical real-world evidence framework for evaluating the impact of changes in radiotherapy.

Autor: Fornacon-Wood I; Division of Cancer Sciences, University of Manchester, Manchester, UK. Electronic address: isabella.fornacon-wood@postgrad.manchester.ac.uk., Mistry H; Division of Cancer Sciences, University of Manchester, Manchester, UK., Johnson-Hart C; Department of Medical Physics, The Christie Hospital NHS Foundation Trust, Manchester, UK., Faivre-Finn C; Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK., O'Connor JPB; Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Diagnostic Radiology, The Christie Hospital NHS Foundation Trust, Manchester, UK., Price GJ; Division of Cancer Sciences, University of Manchester, Manchester, UK.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2022 Nov; Vol. 176, pp. 53-58. Date of Electronic Publication: 2022 Sep 20.
DOI: 10.1016/j.radonc.2022.09.009
Abstrakt: Purpose: 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.
(Crown Copyright © 2022. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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