The Swedish Council on Technology Assessment in Health Care (SBU) Systematic Overview of Radiotherapy for Cancer including a Prospective Survey of Radiotherapy Practice in Sweden 2001--Summary and Conclusions

Abstract

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) and published in 1996. The assessment reviewed the scientific literature up to 1993 on the use of radiotherapy in the treatment of solid tumours, and estimated the costs associated with radiotherapy. It also described the current practise of radiotherapy in Sweden 1992 and compared practise with scientific knowledge. The SBU has now conducted a follow-up study on radiotherapy for cancer, including a review of the scientific literature from 1994 and a prospective survey of radiotherapy practise in Sweden 2001. The following conclusions were drawn: The role of radiotherapy as an important form of treatment for cancer with both curative and palliative intent has been further confirmed. The use of radiotherapy in Sweden has increased and is now at the internationally recommended level. Radiotherapy in Sweden is mostly given in accordance with the scientific evidence but may still be underutilized in certain situations. The resources for radiotherapy are being utilized more efficiently. The costs of radiotherapy are still 5% of the total cost of cancer care, while the cost of an individual treatment (fraction) has decreased. The need for radiotherapy capacity will increase. In addition, half of the treatment equipment will have to be replaced in the next few years.

Design of Clinical Trials of Radiation Combined with Antiangiogenic Therapy

“…Radiation is an important modality in the treatment of cancer as nearly 50% or more of all cancer patients undergo radiotherapy as part of their treatment [1]. Curative radiotherapy can be applied as a single treatment modality, it can be used prior to surgery to increase the likelihood of a complete surgical excision, or it can be administered after surgery to destroy microscopic cancer cells that were not surgically removed.…”

Small field radiotherapy of head and neck cancer patients is responsible for oxidatively damaged DNA/oxidative stress on the level of a whole organism

“…1 As the number of long-term cancer survivals increases, late complication of the therapy will become an increasingly important concern to both patients and physicians.…”

Expert opinions – consensus documents – systematic overviews – is the value for clinicians increasing?

“…when the knowledge is just available and the uncertainties about how clinical care should be affected, it was not considered appropriate to gather a large group of experts or have the document subject to an extensive external review process, motivating the word consensus . These two reports by experts [1,2] can not be considered to have same impact as for example the Swedish Council on Technology and Assessment in Health Care (SBU) overviews, also done by a group of experts, but usually extensively scrutinized prior to publication [3,4]. Neither can they have the same impact as similar documents published in other countries, like the ones from the National Institute for Clinical Excellence (NICE) published for the UK National Health Service or the Cochrane Reviews.…”