Intensity Modulated Radiation Therapy

Size: px
Start display at page:

Download "Intensity Modulated Radiation Therapy"

Transcription

1 [Year] Health Technology Assessment Intensity Modulated Radiation Therapy Final Evidence Report September 6, 2012 Health Technology Assessment Program (HTA) Washington State Health Care Authority PO Box Olympia, WA (360)

2 Intensity Modulated Radiation Therapy September 6, 2012 Center for Evidence-based Policy Oregon Health & Science University 3455 SW US Veterans Hospital Road Mailstop SN-4N, Portland, OR Phone: Fax:

3 About the Center for Evidence-based Policy The Center for Evidence-based Policy (Center) is recognized as a national leader in evidencebased decision making and policy design. The Center understands the needs of policymakers and supports public organizations by providing reliable information to guide decisions, maximize existing resources, improve health outcomes, and reduce unnecessary costs. The Center specializes in ensuring diverse and relevant perspectives are considered, and appropriate resources are leveraged to strategically address complex policy issues with highquality evidence and collaboration. The Center is based at Oregon Health & Science University in Portland, Oregon. Nature and Purpose of Technology Assessments This technology assessment report is based on research conducted by a contracted technology assessment center, with updates as contracted by the Washington State Health Care Authority. This report is an independent assessment of the technology question(s) described based on accepted methodological principles. The findings and conclusions contained herein are those of the investigators and authors who are responsible for the content. These findings and conclusions may not necessarily represent the views of the HCA/Agency and thus, no statement in this report shall be construed as an official position or policy of the HCA/Agency. The information in this assessment is intended to assist health care decision makers, clinicians, patients and policy makers in making sound evidence-based decisions that may improve the quality and cost-effectiveness of health care services. Information in this report is not a substitute for sound clinical judgment. Those making decisions regarding the provision of health care services should consider this report in a manner similar to any other medical reference, integrating the information with all other pertinent information to make decisions within the context of individual patient circumstances and resource availability. This document was prepared by the Center for Evidence-based Policy at Oregon Health & Science University (the Center). This document is intended to support organizations and their constituent decision-making bodies to make informed decisions about the provision of health care services. The document is intended as a reference and is provided with the understanding that the Center is not engaged in rendering any clinical, legal, business or other professional advice. The statements in this document do not represent official policy positions of the Center. Researchers and authors involved in preparing this document have no affiliations or financial involvement that conflict with material presented in this document.

4

5 Acknowledgements This report was prepared by: Edgar E. Clark, MD, MHA Aasta Thielke, MPH Heidi Kriz, RD, MPH Kendra Bunker, MPH Katharine Ryan, MPH Robyn Liu, MD, MPH Valerie King, MD, MPH Center for Evidence-based Policy Oregon Health and Science University The tables of evidence were completed with assistance from: Martha Gerrity, MD, MPH, PhD Jennifer Gilbert, MD, MPH Heidi Gullett, MD, MPH Catherine Pettenari, PhD Shannon Vandegriff, BA Hayes, Inc. Suggested Citation: Clark, E.E., Thielke, A., Kriz, H., Bunker, K., Ryan, K., & King, V. (2012). Intensity modulated radiation therapy. Portland, OR: Center for Evidence-based Policy, Oregon Health and Science University.

6

7 Table of Contents Executive Summary... 1 Background Washington State Data PICO and Key Questions Methods Findings Abdomen Brain Breast Female Pelvis Head & Neck Lung Prostate Sarcoma Other Cancers MAUDE Database Guidelines Policy Considerations Overall Summary Limitations of the Evidence Appendix A. Database Search Strategies Appendix B. Excluded Studies... see separate appendix Appendix C. MEDLINE Search Dates by Malignancy Appendix D. Quality Assessment Tools Appendix E. Summary of Findings Tables by Malignancy Appendix F. Evidence Tables by Malignancy Appendix G. Guideline Summary Table Appendix H. Quality Assessment of Guidelines Appendix I. Summary of Federal and Private Payer Policies Appendix J. Peer Review Comments and Disposition... see separate appendix Appendix K. Public Comments and Disposition... see separate appendix

8 Appendix L. MAUDE Database Search Results References

9 List of Abbreviations bdfs biochemical disease-free survival BRT brachytherapy CBTR contralateral breast tumor recurrence CRT conventional radiation therapy also referred to as EBRT 2DCRT two dimensional conventional radiation therapy 3DCRT three dimensional conventional radiation therapy DFS disease-free survival DSS disease-specific survival EBRT external beam radiation therapy GI gastrointestinal GU gastrourinary HR hazard risk IBTR ipsilateral breast tumor recurrence IGRT Image-guided radiation therapy IMRT intensity-modulated radiation therapy MA meta-analysis NSCLC non-small cell lung cancer OR odds ratio OS overall survival PFS progression-free survival QoL quality of life RCT randomized controlled trial RFS recurrence-free survival RR relative risk SCLC small-cell lung cancer SR systematic review

10 TA technology assessment VMAT volumetric-modulated arc therapy

11 Executive Summary Background Clinical and epidemiological overview Over the past ten years, significant advances have been made in the techniques available to deliver external beam radiation therapy (EBRT) as a treatment modality for certain cancers. The goal of these newer techniques is two-fold: to improve the targeting of radiation to the tumor to minimize damage to normal tissue and increase the dose of radiation delivered to the tumor. One of these newer techniques is intensity modulated radiation therapy (IMRT). Intensity modulated radiation therapy, like other forms of EBRT is used as primary treatment or in conjunction with surgery, hormonal therapy and/or chemotherapy; it is used in treatment in primary, recurrent and metastatic cancer. Intensity modulated radiation therapy has been used for treatment of tumors of the central nervous system, head and neck, breast, prostate, gastrointestinal tract, and gynecologic system. It can be used to treat sites previously treated with radiation and areas in close proximity to organs and vulnerable tissue (American College of Radiology & American Society for Radiation Oncology [ACR-ASTRO] 2011). Technology overview Typically, conventional EBRT (also called 2-dimensional conventional radiation therapy (2DCRT) or 3-dimentional conventional radiation therapy (3DCRT)) 1 is delivered in 25 to 50 fractions (doses) delivered five days per week for 5 to 10 weeks. Intensity modulated radiation therapy uses hundreds of radiation beam-shaping devices (collimators) to deliver external beam radiation (Tipton 2011b). The collimators allow the intensity of the radiation to vary during a treatment session thus different doses of radiation can be directed at different areas of the tumor and nearby tissues. The goal of IMRT is to increase radiation to the tumor while reducing radiation exposure to normal tissue. Treatment planning for IMRT involves additional steps to contour the radiation dose to the tumor and to reduce radiation to surrounding tissues; these additional steps and the additional time required to administer each treatment fraction during the course of therapy result in considerably more cost for IMRT than EBRT. Cost information Intensity modulated radiation therapy typically costs approximately twice as much as EBRT. The following approximate charges for IMRT were identified for this report: Non-small cell lung cancer: EBRT$55,000, IMRT $146,000 (Tipton 2011a); Breast cancer (whole breast irradiation): EBRT $9,500, IMRT $17,900 (Suh 2005); Breast cancer (partial breast irradiation): EBRT $7,200, IMRT $9,200 (Suh 2005); and Prostate cancer: EBRT ranging from $10,000 to $27,000, IMRT ranging from $33,000 to $52,000 (Hummel 2010). 1 In this report 2DCRT and 3DCRT are grouped together as conventional radiation therapy (CRT) except where individual studies compare IMRT to either 2DCRT or 3DCRT. Current conventional EBRT is also referred to as CRT. Washington State Health Care Authority HCA 1

12 Policy context Use of new radiation technologies has grown dramatically in the last decade. Among men with prostate cancer receiving external beam radiation, the use of IMRT increased from 29% in 2002 to 82% in 2005 to 96% in 2008 (Jacobs 2012; Sheets 2012). Among women with breast cancer, the likelihood of IMRT use for breast cancer rose from 0.9% in 2001 to 11.2% in 2005 (Smith 2011). Despite this rapid adoption of IMRT, the Federal Food and Drug Administration (FDA) process for approving new radiation therapies does not require a review of safety and efficacy, which has resulted in limited information about efficacy and comparative effectiveness of IMRT. Methods Key Questions KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? Include consideration of progression of treatment in unnecessary or inappropriate ways. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? Including consideration of: a. Gender; b. Age; c. Site and type of cancer; d. Stage and grade of cancer; and e. Setting, provider characteristics, equipment, quality assurance standards and procedures. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? Methods Evidence For this WA HTA report, a search was conducted to identify published systematic reviews (SRs), meta-analyses (MAs), technology assessments (TAs) and individual studies (from April 2002 to April 2012) in the MEDLINE and Cochrane databases. General inclusion criteria: Published, peer reviewed, English-language articles; SRs, TAs, RCTs, and observational comparative study designs (prospective, retrospective, and controlled clinical trials); For KQ 2 (harms), all study designs with a minimum sample size of 50 participants; and 2 Health Technology Assessment HTA

13 o For pediatric populations and/or reports of serious harms (i.e., surgery, hospitalization, mortality), all study designs with a sample size of 20 participants. Specific inclusion criteria malignancy: Breast, Head and Neck, Prostate Minimum sample size of 50 participants; Less prevalent malignancies (abdomen, brain, female pelvis, lung, sarcoma, skin, thyroid, spinal metastases) SRs, TAs, RCTs, observational comparative study designs (prospective, retrospective, and controlled clinical trials) and case series; Minimum sample size of 20 participants; Exclusions included studies published in a non-english language, commentaries, letters, editorials, narrative reviews, and news articles. Studies that focused on aspects of treatment planning, including different dosing regimens, and/or included patients who were concurrently receiving chemotherapy (with the exception of head and neck cancers) were excluded. The methodological quality of the included studies was assessed using standard instruments developed and adapted by the Center for Evidence-based Policy and the MED Project that are modifications of the systems used by National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) (NICE 2009; SIGN 2009). Each study was assigned a rating of good, fair, poor, based on its adherence to recommended methods and potential for biases. The methodological quality of the economic studies was rated (good, fair, poor) using a standard instrument developed and adapted by the Center for Evidence-based Policy and the MED Project that are modifications of the British Medical Journal (Drummond 1996), the Consensus on Health Economic Criteria list (Evers 2005), and the NICE economic evaluation checklist (NICE 2009). The overall strength of evidence was rated (high, moderate, low, very low) using a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system (Guyatt 2008). A systematic review using best evidence methodology was used to search and summarize evidence for Key Questions #1 through #3 as outlined below: A complete search of the Medicaid Evidence-based Decisions (MED) Project primary evidence sources was conducted; Existing high quality SRs and TAs summarized for each Key Question; If there were two or more comparable SRs or TAs identified and one was more recent, of better quality, or more comprehensive, then the other review(s) were excluded; Additional search of the MEDLINE and Cochrane databases completed to identify subsequently published studies. Individual studies published after the search dates of the last high quality review were appraised and synthesized with the results of the high quality SR; and Washington State Health Care Authority HCA 3

14 If there were no high quality reviews identified, a search, appraisal, and summary of primary individual studies was completed for the last 10 years (April 2002 to April 2012). For Key Question #4, all relevant economic evaluations were included. Methods Guidelines A search for relevant clinical practice guidelines was conducted using a list of predetermined high quality sources from the MED Project and additional relevant specialty organizations and associations. Guidelines included were limited to those published after The methodological quality of the guidelines was assessed using an instrument adapted from the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration (AGREE Next Steps Consortium 2009). Each guideline was assigned a rating of good, fair, poor, based on the adherence to recommended methods and the potential for biases. Methods Policies At the direction of the WA HTA program, select payer policies were searched and summarized. Aetna, Blue Cross Blue Shield, GroupHealth, and Medicare National and Local Coverage Determinations were searched using the payers websites. Methods MAUDE Database The Manufacturer and User Facility Device Experience (MAUDE) Database, hosted by the US Food and Drug Administration (FDA), was searched using the terms intensity modulated, intensity modulated radiation therapy, intensity modulated radiotherapy, and imrt. The search was limited to adverse events reports submitted between 2002 and Two reports of serious adverse events were identified and are summarized in Appendix L. Public Comment and Peer Review The topic nomination, draft key questions, and draft version of this report were open to public comment. All comments and references received from the public were reviewed and taken into account in the drafting of the final report. In addition, the draft report was reviewed by two peer reviewers and their comments were also considered in drafting the final report. The full peer reviews and disposition are available in Appendix J. Full comments submitted by the public with disposition are available in Appendix K. Findings This report provides the best available evidence for multiple cancer types. The most completely evaluated cancers are cancers of the head and neck, breast and prostate. For these cancers there are large TAs and several SRs. For many of the other cancers, there are as few as one case series. The evidence consists mostly of case series of which some are designed to compare IMRT with EBRT but many are non-comparative studies that give outcomes or harms results for IMRT without comparison with EBRT. Because of the absence of randomized trials and comparative studies, the strength of the evidence is very low or low for most of the findings. 4 Health Technology Assessment HTA

15 Abdomen (Anus, Esophagus, Liver, Pancreas, Rectum, Stomach, Whole Pelvis Radiation) In this section, tumors of the anus, liver, pancreas, rectum, and stomach and treatments involving whole pelvis radiation are summarized. One study on cancer of the esophagus is included in this section even though the esophagus is not technically in the abdomen. Anal Cancer KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? The overall strength of evidence is very low that IMRT is associated with better 3-year OS, 3- year locoregional control, and 3-year PFS when compared to EBRT for treatment of anal cancer. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? There is very low overall strength of evidence that IMRT had significant reductions in acute greater than Grade 2 nonhematologic toxicity, skin, and mucosal eruptions in the female genital area, and acute Grade 2 diarrhea after treatment compared with EBRT. When treatment is a combination of chemotherapy and IMRT, there is a very low overall strength of evidence that toxicity may be related more to chemotherapy based on one small case series. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? Based on one fair quality case series, the overall strength of evidence is very low that there is no difference in 3-year local control and 3-year OS for IMRT compared to EBRT for the treatment of HIV-positive patients with anal cancer. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? No studies on costs or cost-effectiveness were identified. Esophagus KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? The overall strength of evidence is very low. One small, poor quality case series reported 1-year OS (79%), 2-year OS (38%), and 2-year actuarial loco-regional control of 64%. Due to the lack of a comparative data, no conclusions can be reached regarding clinical effectiveness. Washington State Health Care Authority HCA 5

16 KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? The overall strength evidence is very low. One poor quality case series reported moderate levels of acute and chronic complications. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? No studies on costs or cost-effectiveness were identified. Liver KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? The overall strength of evidence is very low. Three poor quality case series reported mean of 5 to 16 months. Due to the lack of a comparative data, no conclusions can be reached regarding clinical effectiveness. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? The overall strength of evidence is very low. Among patients treated with IMRT in one poor quality case series for hepatocellular cancer, approximately 28% of patients experienced less than or equal to Grade 2 hepatic toxicity. Two poor quality case series reported moderate levels of nausea, vomiting and changes in hepatic function. Due to the lack of comparative data, no conclusions can be reached regarding relative harms. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? No studies on costs or cost-effectiveness were identified. Pancreas KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? 6 Health Technology Assessment HTA

17 The overall strength of evidence is very low. One poor quality case series reported 1- and 2-year OS rates of 79% and 40%, respectively. Due to the lack of comparative data, no conclusions can be reached regarding the clinical effectiveness. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? The overall strength of evidence is very low. One poor quality case series reported acute and chronic toxicity GI in 9% of patients. Due to the lack of comparative data, no conclusions can be reached regarding relative harms. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? The overall strength of evidence is low. One poor quality cost-effectiveness modeling study calculated that IMRT had an ICER of $1,584,100/QALY compared to EBRT. Rectum KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? The overall strength of evidence is very low. One poor quality case series of 63 patients reported 2-year PFS and OS rates of 90% and 96%, respectively. Due to the lack of comparative data, no conclusions can be reached regarding the clinical effectiveness. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? The overall strength of evidence is very low. One poor quality case series reported relatively low levels of complications. Due to the lack of comparative data, no conclusions can be reached regarding the relative harms. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? No studies on costs or cost-effectiveness were identified. Washington State Health Care Authority HCA 7

18 Stomach KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? The overall strength of evidence is very low. Based on two small, poor quality cohort studies, there is inconsistent evidence on whether IMRT improves 2-year OS compared with 3DCRT. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? The overall strength of evidence is very low. The two poor quality cohort studies report decrease in renal function measured by creatinine levels for 3DCRT compared to IMRT; the difference was significant in one study but not the other study. The effect of chemotherapy on renal toxicity is not investigated in either study. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? No studies on costs or cost-effectiveness were identified. Whole Pelvis Radiation KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? No studies on effectiveness were identified. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? Among patients treated with IMRT for whole pelvis radiation 2, there is very low overall strength of evidence that there were no significant differences in toxicity frequency for IMRT compared to EBRT. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? 2 Study included patients with endometrium, cervical, rectum, anal canal, and bladder cancers. 8 Health Technology Assessment HTA

19 No studies on costs or cost-effectiveness were identified. Brain In this section, evidence on intracranial tumors is summarized. There is limited evidence for all tumor types. No other cancers were identified for this section. The sections are divided up by intracranial malignancy and include the following: astrocytomas, brain metastases, glioblastomas, high-grade gliomas, medulloblastomas, meningiomas, pituitary adenomas, and sacral chodomas. Malignancies are discussed as they were reported in literature. For instance, although astrocytomas and glioblastoma multiforme are types of gliomas, they are discussed in separate sections as they were reported by individual studies. Astrocytoma KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? There is very low overall strength of evidence that patients treated by IMRT had significantly greater 1-year OS and PFS than EBRT. There is very low overall strength of evidence that the IMRT group had greater 2-year OS and PFS compared to EBRT. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? There is very low overall strength of evidence. One fair quality cohort study reported that patients undergoing treatment with IMRT for astrocytoma had fewer Grade 1 toxicities, but more Grade 2 and 3 toxicities than patients undergoing EBRT. Due to the limitations of small sample size, no conclusions can be reached regarding relative harms. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? No studies on costs or cost-effectiveness were identified. Brain metastases KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? The overall strength of evidence is very low. The sole study identified did not compare treatment groups, which precluded any conclusions about the relative effectiveness of volumemodulated arc therapy (VMAT) treatment for patients with brain metastases. Patients treated Washington State Health Care Authority HCA 9

20 solely by VMAT had six-month OS of 55.1%, while patients treated by surgery and VMAT had six-month OS of 72.0%. Further, individuals undergoing VMAT treatment had significantly decreased physical functioning and role functioning scores on self-assessments of QOL. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? The overall strength of evidence is very low. Given the lack of a comparator, no conclusions can be reached regarding the relative harms of VMAT treatment. As reported by one fair quality case series, patients treated by VMAT with brain metastases experienced Grade 1 and 2 alopecia. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. KQ 4: What is the evidence of cost and cost-effectiveness of IMRT compared to EBRT? No studies on costs or cost-effectiveness were identified. Glioblastoma multiforme KQ 1: What is the evidence of effectiveness for intensity modulated radiation therapy compared to conventional external beam radiation therapy (EBRT) for patients with cancer by site and type of cancer? The overall strength of evidence is very low. As reported by three case series, the 2-year OS ranged from 0% to 55.6%, 2-year PFS ranged from 0% to 53.6%, median PFS was 9.0 months (95% CI, ), and median OS ranged from 14.4 to 20.1 months. Due to the lack of a comparator, no conclusions can be drawn. KQ 2: What are the potential harms of IMRT compared to conventional external beam radiation therapy (EBRT)? What is the incidence of these harms? The overall strength of evidence for all harms is very low. One fair quality case series reports on IMRT alone; two additional case series (one fair quality, one poor quality) report on IMRT plus chemotherapy. Results from the case series are inconsistent. One case series reported Grade 3 or higher toxicity in 38% (8 patients); one case series reported Grade 3 neurotoxicity in 16% (6 patients); and one case series reported no Grade 3 or higher toxicity. Due to the lack of comparative data, no conclusions can be reached regarding relative harms. KQ 3: What is the evidence that IMRT has differential efficacy or safety issues in subpopulations? No studies on subpopulations were identified. 10 Health Technology Assessment HTA

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Head and Neck File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_head_and_neck

More information

The Science behind Proton Beam Therapy

The Science behind Proton Beam Therapy The Science behind Proton Beam Therapy Anthony Zietman MD Shipley Professor of Radiation Oncology Massachusetts General Hospital Harvard Medical School Principles underlying Radiotherapy Radiation related

More information

intensity_modulated_radiation_therapy_imrt_of_abdomen_and_pelvis 11/2009 5/2016 5/2017 5/2016

intensity_modulated_radiation_therapy_imrt_of_abdomen_and_pelvis 11/2009 5/2016 5/2017 5/2016 Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Abdomen File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_abdomen_and_pelvis

More information

Radiation Therapy for Prostate Cancer: Treatment options and future directions

Radiation Therapy for Prostate Cancer: Treatment options and future directions Radiation Therapy for Prostate Cancer: Treatment options and future directions David Weksberg, M.D., Ph.D. PinnacleHealth Cancer Institute September 12, 2015 Radiation Therapy for Prostate Cancer: Treatment

More information

The Clinical Case for Individualized Use of Proton Beam Therapy

The Clinical Case for Individualized Use of Proton Beam Therapy The Clinical Case for Individualized Use of Proton Beam Therapy According to physicians and researchers who use proton beam therapy, the technology is a long-needed, excellent alternative to use of conventional

More information

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

More information

FAQ About Prostate Cancer Treatment and SpaceOAR System

FAQ About Prostate Cancer Treatment and SpaceOAR System FAQ About Prostate Cancer Treatment and SpaceOAR System P. 4 Prostate Cancer Background SpaceOAR Frequently Asked Questions (FAQ) 1. What is prostate cancer? The vast majority of prostate cancers develop

More information

Implementation Date: April 2015 Clinical Operations

Implementation Date: April 2015 Clinical Operations National Imaging Associates, Inc. Clinical guideline PROSTATE CANCER Original Date: March 2011 Page 1 of 5 Radiation Oncology Last Review Date: March 2015 Guideline Number: NIA_CG_124 Last Revised Date:

More information

Table of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms

Table of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms Definitive and Adjuvant Radiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation

More information

Corporate Medical Policy Intensity-Modulated Radiation Therapy (IMRT) of the Prostate

Corporate Medical Policy Intensity-Modulated Radiation Therapy (IMRT) of the Prostate Corporate Medical Policy Intensity-Modulated Radiation Therapy (IMRT) of the Prostate File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_the_prostate

More information

Robotic Assisted Surgery

Robotic Assisted Surgery WA Health Technology Assessment Robotic Assisted Surgery Health Technology Assessment Program UPDATED FINAL EVIDENCE REPORT May 3, 2012 Health Technology Assessment Program (HTA) Washington State Health

More information

Current Status and Future Direction of Proton Beam Therapy

Current Status and Future Direction of Proton Beam Therapy Current Status and Future Direction of Proton Beam Therapy National Cancer Center Hospital East Division of Radiation Oncology and Particle Therapy Tetsuo Akimoto Comparison of status of particle therapy

More information

Intensity-Modulated Radiation Therapy (IMRT)

Intensity-Modulated Radiation Therapy (IMRT) Scan for mobile link. Intensity-Modulated Radiation Therapy (IMRT) Intensity-modulated radiotherapy (IMRT) uses linear accelerators to safely and painlessly deliver precise radiation doses to a tumor while

More information

Our Facility. Advanced clinical center with the newest and highly exact technology for treatment of patients with cancer pencil beam

Our Facility. Advanced clinical center with the newest and highly exact technology for treatment of patients with cancer pencil beam PTC Czech The main goal of radiotherapy is to irreversibly damage tumor cells, whereas the cells of healthy tissue are damaged only reversibly or not at all. Proton therapy currently comes closest to this

More information

Proton Therapy: Cutting Edge Treatment for Cancerous Tumors. By: Cherilyn G. Murer, JD, CRA

Proton Therapy: Cutting Edge Treatment for Cancerous Tumors. By: Cherilyn G. Murer, JD, CRA Proton Therapy: Cutting Edge Treatment for Cancerous Tumors By: Cherilyn G. Murer, JD, CRA Introduction Put simply, proton therapy is a new cutting edge cancer treatment that promises better outcomes for

More information

at a critical moment Physician Suggestion Line...

at a critical moment Physician Suggestion Line... Radiation Oncology Exceptional care at a critical moment When your patients require radiation therapy, they deserve the very best care available to them. The Department of Radiation Oncology provides exceptional

More information

Brain Tumor Treatment

Brain Tumor Treatment Scan for mobile link. Brain Tumor Treatment Brain Tumors Overview A brain tumor is a group of abnormal cells that grows in or around the brain. Tumors can directly destroy healthy brain cells. They can

More information

Comparative Effectiveness of Proton Irradiation Treatment

Comparative Effectiveness of Proton Irradiation Treatment Department of Veterans Affairs Health Services Research & Development Service Comparative Effectiveness of Proton Irradiation Treatment January 2015 Prepared for: Department of Veterans Affairs Veterans

More information

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness Investigators: Paul G. Shekelle, MD, PhD, Director Alicia R. Maher, MD Clinical

More information

AMERICAN BRAIN TUMOR ASSOCIATION. Proton Therapy

AMERICAN BRAIN TUMOR ASSOCIATION. Proton Therapy AMERICAN BRAIN TUMOR ASSOCIATION Proton Therapy Acknowledgements About the American Brain Tumor Association Founded in 1973, the American Brain Tumor Association (ABTA) was the first national nonprofit

More information

TITLE: Comparison of the dosimetric planning of partial breast irradiation with and without the aid of 3D virtual reality simulation (VRS) software.

TITLE: Comparison of the dosimetric planning of partial breast irradiation with and without the aid of 3D virtual reality simulation (VRS) software. SAMPLE CLINICAL RESEARCH APPLICATION ABSTRACT: TITLE: Comparison of the dosimetric planning of partial breast irradiation with and without the aid of 3D virtual reality simulation (VRS) software. Hypothesis:

More information

Esophageal Cancer Treatment

Esophageal Cancer Treatment Scan for mobile link. Esophageal Cancer Treatment What is Esophageal Cancer? Esophageal cancer occurs when cancer cells develop in the esophagus, a long, tube-like structure that connects the throat and

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Intensity Modulated Radiation Therapy for Tumors of the Central File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_for_tumors

More information

Proton Therapy Center Czech

Proton Therapy Center Czech Proton Therapy Center Czech The main goal of radiotherapy is to irreversibly damage tumor cells, whereas the cells of healthy tissue are damaged only reversibly or not at all. Proton therapy currently

More information

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); as04@aub.edu.lb Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT

More information

Small Cell Lung Cancer

Small Cell Lung Cancer Small Cell Lung Cancer Types of Lung Cancer Non-small cell carcinoma (NSCC) (87%) Adenocarcinoma (38%) Squamous cell (20%) Large cell (5%) Small cell carcinoma (13%) Small cell lung cancer is virtually

More information

Summary of Harms from Screening and Treatment for Prostate Cancer

Summary of Harms from Screening and Treatment for Prostate Cancer DRAFT: Advice from Dr John Childs MoH advisor Summary of Harms from Screening and Treatment for Prostate Cancer There are minimal risks directly attributable to PSA testing or transrectal ultrasound (TRUS)

More information

CLINICAL POLICY Department: Medical Management Document Name: Opdivo Reference Number: CP.PHAR.121 Effective Date: 07/15

CLINICAL POLICY Department: Medical Management Document Name: Opdivo Reference Number: CP.PHAR.121 Effective Date: 07/15 Page: 1 of 6 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted

More information

Advances In Chemotherapy For Hormone Refractory Prostate Cancer. TAX 327 study results & SWOG 99-16 study results presented at ASCO 2004

Advances In Chemotherapy For Hormone Refractory Prostate Cancer. TAX 327 study results & SWOG 99-16 study results presented at ASCO 2004 Ronald de Wit Rotterdam Cancer Institute The Netherlands Advances In Chemotherapy For Hormone Refractory Prostate Cancer TAX 327 study results & SWOG 99-16 study results presented at Slide 1 Prostate Cancer

More information

Medical Marijuana Use in Patients with History of SCCHN Treated with Radiotherapy

Medical Marijuana Use in Patients with History of SCCHN Treated with Radiotherapy HEALTH SERVICES RESEARCH Assessment the Impact of Real-time Tumor Tracking & Reduced Planning Target Volume Margins on Quality-of-Life in Prostate Cancer Patients Treatment with Intensity Modulated Radiotherapy

More information

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness Department of Veterans Affairs Health Services Research & Development Service Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness

More information

Effective Health Care Program

Effective Health Care Program Comparative Effectiveness Review Number 152 Effective Health Care Program Treatment of Nonmetastatic Muscle-Invasive Bladder Cancer Executive Summary Background Nature and Burden of Nonmetastatic Muscle-Invasive

More information

Stomach (Gastric) Cancer. Prof. M K Mahajan ACDT & RC Bathinda

Stomach (Gastric) Cancer. Prof. M K Mahajan ACDT & RC Bathinda Stomach (Gastric) Cancer Prof. M K Mahajan ACDT & RC Bathinda Gastric Cancer Role of Radiation Layers of the Stomach Mucosa Submucosa Muscularis Serosa Stomach and Regional Lymph Nodes Stomach and Regional

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: PS Inj - Alimta Therapeutic Class: Antineoplastic Agents Therapeutic Sub-Class: Antifolates Client: PS Inj Approval Date: 8/2/2004 Revision Date: 12/5/2006 I. BENEFIT

More information

Radiation Therapy for Cancer Treatment

Radiation Therapy for Cancer Treatment Radiation Therapy for Cancer Treatment Guest Expert: Kenneth, MD Associate Professor of Therapeutic Radiology www.wnpr.org www.yalecancercenter.org Welcome to Yale Cancer Center Answers with Dr. Ed and

More information

Radiation Fibrosis Fact Sheet

Radiation Fibrosis Fact Sheet Radiation Fibrosis Fact Sheet What is Radiation Fibrosis Syndrome (RFS), and when can it occur? Radiation Fibrosis Syndrome (RFS) is a term used to describe the multiple clinical symptoms associated with

More information

Goals and Objectives: Breast Cancer Service Department of Radiation Oncology

Goals and Objectives: Breast Cancer Service Department of Radiation Oncology Goals and Objectives: Breast Cancer Service Department of Radiation Oncology The breast cancer service provides training in the diagnosis, management, treatment, and follow-up of breast malignancies, including

More information

Early Prostate Cancer: Questions and Answers. Key Points

Early Prostate Cancer: Questions and Answers. Key Points CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Early Prostate Cancer:

More information

Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group

Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Lotte Holm Land MD, ph.d. Onkologisk Afd. R. OUH Kræft og komorbiditet - alle skal

More information

Number. Source: Vital Records, M CDPH

Number. Source: Vital Records, M CDPH Epidemiology of Cancer in Department of Public Health Revised April 212 Introduction The general public is very concerned about cancer in the community. Many residents believe that cancer rates are high

More information

DECISION AND SUMMARY OF RATIONALE

DECISION AND SUMMARY OF RATIONALE DECISION AND SUMMARY OF RATIONALE Indication under consideration Clinical evidence Clofarabine in the treatment of relapsed acute myeloid leukaemia (AML) The application was for clofarabine to remain in

More information

Prostate Cancer Treatment: What s Best for You?

Prostate Cancer Treatment: What s Best for You? Prostate Cancer Treatment: What s Best for You? Prostate Cancer: Radiation Therapy Approaches I. Choices There is really a variety of options in prostate cancer management overall and in radiation therapy.

More information

CheckMate -057, a Pivotal III Opdivo (nivolumab) Lung Cancer Trial, Stopped Early

CheckMate -057, a Pivotal III Opdivo (nivolumab) Lung Cancer Trial, Stopped Early April 21, 2015 CheckMate -057, a Pivotal III Opdivo (nivolumab) Lung Cancer Trial, Stopped Early Opdivo Demonstrates Superior Overall Survival Compared to Docetaxel in Patients with Previously-Treated

More information

Radiation Therapy for Prostate Cancer

Radiation Therapy for Prostate Cancer Radiation Therapy for Prostate Cancer Introduction Cancer of the prostate is the most common form of cancer that affects men. About 240,000 American men are diagnosed with prostate cancer every year. Your

More information

An Introduction to PROSTATE CANCER

An Introduction to PROSTATE CANCER An Introduction to PROSTATE CANCER Being diagnosed with prostate cancer can be a life-altering experience. It requires making some very difficult decisions about treatments that can affect not only the

More information

IEHP UM Subcommittee Approved Authorization Guidelines Proton Beam Radiation therapy for Prostate Cancer

IEHP UM Subcommittee Approved Authorization Guidelines Proton Beam Radiation therapy for Prostate Cancer Proton Beam Radiation therapy for Prostate Cancer Policy: The use of Proton Beam Therapy (PBT) in Prostate cancer has not been established as more effective than other forms of External Beam Radiation

More information

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology Oncology Annual Report: Prostate Cancer 25 Update By: John Konefal, MD, Radiation Oncology Prostate cancer is the most common cancer in men, with 232,9 new cases projected to be diagnosed in the U.S. in

More information

Treating Prostate Cancer

Treating Prostate Cancer Treating Prostate Cancer A Guide for Men With Localized Prostate Cancer Most men have time to learn about all the options for treating their prostate cancer. You have time to talk with your family and

More information

Radiation Therapy in the Treatment of

Radiation Therapy in the Treatment of Lung Cancer Radiation Therapy in the Treatment of Lung Cancer JMAJ 46(12): 537 541, 2003 Kazushige HAYAKAWA Professor and Chairman, Department of Radiology, Kitasato University School of Medicine Abstract:

More information

Clinical Trials and Radiation Treatment. Gerard Morton Odette Cancer Centre Sunnybrook Research Institute University of Toronto

Clinical Trials and Radiation Treatment. Gerard Morton Odette Cancer Centre Sunnybrook Research Institute University of Toronto Clinical Trials and Radiation Treatment Gerard Morton Odette Cancer Centre Sunnybrook Research Institute University of Toronto What I will cover.. A little about radiation treatment The clinical trials

More information

SMALL CELL LUNG CANCER

SMALL CELL LUNG CANCER Protocol for Planning and Treatment The process to be followed in the management of: SMALL CELL LUNG CANCER Patient information given at each stage following agreed information pathway 1. DIAGNOSIS New

More information

Brain Cancer. This reference summary will help you understand how brain tumors are diagnosed and what options are available to treat them.

Brain Cancer. This reference summary will help you understand how brain tumors are diagnosed and what options are available to treat them. Brain Cancer Introduction Brain tumors are not rare. Thousands of people are diagnosed every year with tumors of the brain and the rest of the nervous system. The diagnosis and treatment of brain tumors

More information

How valuable is a cancer therapy? It depends on who you ask.

How valuable is a cancer therapy? It depends on who you ask. How valuable is a cancer therapy? It depends on who you ask. Comparing and contrasting the ESMO Magnitude of Clinical Benefit Scale with the ASCO Value Framework in Cancer Ram Subramanian Kevin Schorr

More information

PSA Screening for Prostate Cancer Information for Care Providers

PSA Screening for Prostate Cancer Information for Care Providers All men should know they are having a PSA test and be informed of the implications prior to testing. This booklet was created to help primary care providers offer men information about the risks and benefits

More information

Activity of pemetrexed in thoracic malignancies

Activity of pemetrexed in thoracic malignancies Activity of pemetrexed in thoracic malignancies Results of phase III clinical studies of pemetrexed in malignant pleural mesothelioma and non-small cell lung cancer show benefit P emetrexed (Alimta) is

More information

In 1946 Harvard physicist Robert Wilson (1914-2000) suggested:

In 1946 Harvard physicist Robert Wilson (1914-2000) suggested: In 1946 Harvard physicist Robert Wilson (1914-2000) suggested: Protons can be used clinically Accelerators are available Maximum radiation dose can be placed into the tumor Proton therapy provides sparing

More information

Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance

Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance Acknowledgements and Disclaimer The collection of cancer incidence data used in this

More information

Lung cancer forms in tissues of the lung, usually in the cells lining air passages.

Lung cancer forms in tissues of the lung, usually in the cells lining air passages. Scan for mobile link. Lung Cancer Lung cancer usually forms in the tissue cells lining the air passages within the lungs. The two main types are small-cell lung cancer (usually found in cigarette smokers)

More information

Clinical Education A comprehensive and specific training program. carry out effective treatments from day one

Clinical Education A comprehensive and specific training program. carry out effective treatments from day one Proton Therapy Clinical Education A comprehensive and specific training program carry out effective treatments from day one Forewarned is forearmed Although over 100,000 patients have been treated in proton

More information

After Radiation Therapy

After Radiation Therapy After Radiation Therapy CHRISTOPHER G. JORDAN, DO, FACOI UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER DIRECTOR, SECTION OF HEMATOLOGY & ONCOLOGY MAY 1, 2015 A brief Understanding of Radiation Multiple

More information

Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy) for Paediatric Cancer Treatment

Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy) for Paediatric Cancer Treatment Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy) for Paediatric Cancer Treatment Reference: NHS England xxx/x/x 1 Clinical Commissioning Policy: Proton Beam Radiotherapy (High Energy)

More information

Treatment of Small Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians (ACCP) Guideline

Treatment of Small Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians (ACCP) Guideline Treatment of Small Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians (ACCP) Guideline An ASCO Endorsement of Treatment of Small Cell Lung Cancer:

More information

Frequently Asked Questions About Ovarian Cancer

Frequently Asked Questions About Ovarian Cancer Media Contact: Gerri Gomez Howard Cell: 303-748-3933 gerri@gomezhowardgroup.com Frequently Asked Questions About Ovarian Cancer What is ovarian cancer? Ovarian cancer is a cancer that forms in tissues

More information

Radiation Protection in Radiotherapy

Radiation Protection in Radiotherapy Radiation Protection in Radiotherapy Albert Lisbona Medical Physics Department CLCC Nantes Atlantique 44805 Saint-Herblain France a-lisbona@nantes.fnclcc.fr Radiation therapy The lecture is oriented to

More information

Evidence-based Synthesis Program. October 2012

Evidence-based Synthesis Program. October 2012 Department of Veterans Affairs Health Services Research & Development Service Effects of Health Plan-Sponsored Fitness Center Benefits on Physical Activity, Health Outcomes, and Health Care Costs and Utilization:

More information

A new score predicting the survival of patients with spinal cord compression from myeloma

A new score predicting the survival of patients with spinal cord compression from myeloma A new score predicting the survival of patients with spinal cord compression from myeloma (1) Sarah Douglas, Department of Radiation Oncology, University of Lubeck, Germany; sarah_douglas@gmx.de (2) Steven

More information

The Need for Accurate Lung Cancer Staging

The Need for Accurate Lung Cancer Staging The Need for Accurate Lung Cancer Staging Peter Baik, DO Thoracic Surgery Cancer Treatment Centers of America Oklahoma Osteopathic Association 115th Annual Convention Financial Disclosures: None 2 Objectives

More information

PROTON THERAPY FREQUENTLY ASKED QUESTIONS

PROTON THERAPY FREQUENTLY ASKED QUESTIONS PROTON THERAPY FREQUENTLY ASKED QUESTIONS Table of contents 1. What is cancer?... 2 2. How is cancer treated?... 3 3. What is proton therapy?... 4 4. What are the clinical benefits of proton therapy?...

More information

Ovarian Cancer. in Georgia, 1999-2003. Georgia Department of Human Resources Division of Public Health

Ovarian Cancer. in Georgia, 1999-2003. Georgia Department of Human Resources Division of Public Health Ovarian Cancer in Georgia, 1999-23 Georgia Department of Human Resources Division of Public Health Acknowledgments Georgia Department of Human Resources......B. J. Walker, Commissioner Division of Public

More information

Lung Cancer Treatment

Lung Cancer Treatment Scan for mobile link. Lung Cancer Treatment Lung cancer overview More than one in four of all diagnosed cancers involve the lung, and lung cancer remains the most common cancer-related cause of death among

More information

Patient Guide. Brachytherapy: The precise answer for tackling breast cancer. Because life is for living

Patient Guide. Brachytherapy: The precise answer for tackling breast cancer. Because life is for living Patient Guide Brachytherapy: The precise answer for tackling breast cancer Because life is for living This booklet is designed to provide information that helps women who have been diagnosed with early

More information

Recommendations for the management of early breast cancer

Recommendations for the management of early breast cancer Recommendations for the management of early breast cancer in women with an identified BRCA1 or BRCA2 gene mutation or at high risk of a gene mutation FEBRUARY 2014 Incorporates published evidence to August

More information

SAFE AND INNOVATIVE RADIATION THERAPY. Advanced treatment options including the CyberKnife System

SAFE AND INNOVATIVE RADIATION THERAPY. Advanced treatment options including the CyberKnife System SAFE AND INNOVATIVE RADIATION THERAPY Advanced treatment options including the CyberKnife System Surgery-Free Cancer Treatment in Suffolk County If you need treatment for cancer or non-cancerous tumors,

More information

Proton Therapy. What is proton therapy and how is it used?

Proton Therapy. What is proton therapy and how is it used? Scan for mobile link. Proton Therapy Proton therapy delivers radiation to tumor tissue in a much more confined way than conventional photon therapy thus allowing the radiation oncologist to use a greater

More information

C a nc e r C e nter. Annual Registry Report

C a nc e r C e nter. Annual Registry Report C a nc e r C e nter Annual Registry Report 214 214 Cancer Registry Report Larraine A. Tooker, CTR Please note that the 214 Cancer Registry Annual Report is created in 214, but it reflects data on cases

More information

Technology Assessment

Technology Assessment Technology Assessment Technology Assessment Program Comparative evaluation of radiation treatments for clinically localized prostate cancer: an update Prepared for: Agency for Healthcare Research and Quality

More information

Does Radiation Treatment of Prostate Cancer Increase Risk for Rectal Cancer? The Perfect Storm

Does Radiation Treatment of Prostate Cancer Increase Risk for Rectal Cancer? The Perfect Storm NAACCR Conference, Austin, TX June 13, 2013 In Collaboration with: Does Radiation Treatment of Prostate Cancer Increase Risk for Rectal Cancer? The Perfect Storm John W. Morgan, DrPH, CPH, Brice Jabo,

More information

Foundations of Oncology Nursing Practice

Foundations of Oncology Nursing Practice Foundations of Oncology Nursing Practice Course Syllabus Course Lead:, RN, MN, BScN, CON(C) Associate Faculty:, RN, CON(C) Last updated January 27, 2011 Course Description: This online course will introduce

More information

There must be an appropriate administrative structure for each residency program.

There must be an appropriate administrative structure for each residency program. Specific Standards of Accreditation for Residency Programs in Radiation Oncology 2015 VERSION 3.0 INTRODUCTION The purpose of this document is to provide program directors and surveyors with an interpretation

More information

PROTON BEAM THERAPY FOR PROSTATE CANCER. A Technology Assessment

PROTON BEAM THERAPY FOR PROSTATE CANCER. A Technology Assessment PROTON BEAM THERAPY FOR PROSTATE CANCER A Technology Assessment INTRODUCTION The California Technology Assessment Forum is requested to review the scientific evidence for the use of proton therapy for

More information

Carcinoma of the Cervix. Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology

Carcinoma of the Cervix. Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology Carcinoma of the Cervix Kathleen M. Schmeler, MD Associate Professor Department of Gynecologic Oncology Cervical Cancer Treatment Treatment Microinvasive (Stage IA1): Simple (extrafascial) hysterectomy/cone

More information

American Urological Association (AUA) Guideline

American Urological Association (AUA) Guideline 1 (AUA) Guideline Approved by the AUA Board of Directors April 2013 Authors disclosure of potential conflicts of interest and author/staff contributions appear at the end of the article. 2013 by the American

More information

Current Status and Perspectives of Radiation Therapy for Breast Cancer

Current Status and Perspectives of Radiation Therapy for Breast Cancer Breast Cancer Current Status and Perspectives of Radiation Therapy for Breast Cancer JMAJ 45(10): 434 439, 2002 Masahiro HIRAOKA, Masaki KOKUBO, Chikako YAMAMOTO and Michihide MITSUMORI Department of Therapeutic

More information

FATAL PNEUMONITIS ASSOCIATED WITH INTENSITY-MODULATED RADIATION THERAPY FOR MESOTHELIOMA

FATAL PNEUMONITIS ASSOCIATED WITH INTENSITY-MODULATED RADIATION THERAPY FOR MESOTHELIOMA RAPID COMMUNICATION FATAL PNEUMONITIS ASSOCIATED WITH INTENSITY-MODULATED RADIATION THERAPY FOR MESOTHELIOMA AARON M. ALLEN, M.D.,* MARIA CZERMINSKA, M.S.,* PASI A. JÄNNE, M.D., PH.D., DAVID J. SUGARBAKER,

More information

Adjuvant Therapy for Breast Cancer: Questions and Answers

Adjuvant Therapy for Breast Cancer: Questions and Answers CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Adjuvant Therapy for Breast

More information

POLICY A. INDICATIONS

POLICY A. INDICATIONS Alimta (pemetrexed) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage Original Effective Date: 09/01/2007 Current Effective Date: 10/01/2015 POLICY A. INDICATIONS The indications below

More information

A Revolution in the Fight Against Cancer. What TomoTherapy Technology Means to You

A Revolution in the Fight Against Cancer. What TomoTherapy Technology Means to You A Revolution in the Fight Against Cancer What TomoTherapy Technology Means to You Cancer Treatment that Revolves Around You When it comes to choosing the right treatment for your cancer, your team of healthcare

More information

CONQUERING CANCER SAVING LIVES. Mayo Clinic Proton Beam Therapy Program

CONQUERING CANCER SAVING LIVES. Mayo Clinic Proton Beam Therapy Program CONQUERING CANCER SAVING LIVES Mayo Clinic Proton Beam Therapy Program A MALIGNANT TUMOR IS A TYRANT Cancer takes all the body s resources for itself invading and displacing surrounding tissues. Abolishing

More information

Attached from the following page is the press release made by BMS for your information.

Attached from the following page is the press release made by BMS for your information. July 22, 2015 CheckMate -025 (global clinical trial), a Pivotal Phase III Opdivo (nivolumab) Renal Cancer Trial Stopped Early (PRINCETON, NJ, July 20, 2015) Bristol-Myers Squibb Company (NYSE:BMY) announced

More information

The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy March 2, 2015 V2

The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy March 2, 2015 V2 The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy March 2, 2015 V2 Taxonomy Data Category Number Description Data Fields and Menu Choices 1. Impact 1.1 Incident

More information

Breast cancer treatment for elderly women: a systematic review

Breast cancer treatment for elderly women: a systematic review Breast cancer treatment for elderly women: a systematic review Gerlinde Pilkington Rumona Dickson Anna Sanniti Funded by the NCEI and POI Elderly people less likely to receive chemotherapy than younger

More information

A Woman s Guide to Prostate Cancer Treatment

A Woman s Guide to Prostate Cancer Treatment A Woman s Guide to Prostate Cancer Treatment Supporting the man in your life Providing prostate cancer support and resources for women and families WOMEN AGAINST PROSTATE CANCER A Woman s Guide to Prostate

More information

Uterine sarcomas are very rare. They are responsible for only 1 to 5 percent of all malignancies

Uterine sarcomas are very rare. They are responsible for only 1 to 5 percent of all malignancies EVERYONE S GUIDE FOR CANCER THERAPY Malin Dollinger, MD, Ernest H. Rosenbaum, MD, Margaret Tempero, MD, and Sean Mulvihill, MD 4 th Edition 2001 Uterus: Uterine Sarcomas Jeffrey L. Stern, MD Uterine sarcomas

More information

Advanced Radiation Therapy of Cancer by Proton Beam

Advanced Radiation Therapy of Cancer by Proton Beam March 20th, 2014 Advanced Radiation Therapy of Cancer by Proton Beam Fukui Prefectural Hospital Proton Therapy Center Yamamoto, Kazutaka Wave (electromagnetic wave) IR (Ionizing) Radiation 700 400 350~100

More information

Protons vs. CyberKnife. Protons vs. CyberKnife. Page 1 UC SF. What are. Alexander R. Gottschalk, M.D., Ph.D.

Protons vs. CyberKnife. Protons vs. CyberKnife. Page 1 UC SF. What are. Alexander R. Gottschalk, M.D., Ph.D. Protons vs. CyberKnife UC SF Protons vs. CyberKnife UC SF Alexander R. Gottschalk, M.D., Ph.D. Associate Professor and Director of the CyberKnife Radiosurgery Program Department of Radiation Oncology University

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium pemetrexed 500mg infusion (Alimta ) No. (192/05) Eli Lilly 8 July 2005 The Scottish Medicines Consortium has completed its assessment of the above product and advises NHS

More information

Chapter I Overview Chapter Contents

Chapter I Overview Chapter Contents Chapter I Overview Chapter Contents Table Number Contents I-1 Estimated New Cancer Cases and Deaths for 2005 I-2 53-Year Trends in US Cancer Death Rates I-3 Summary of Changes in Cancer Incidence and Mortality

More information

The Brain and Spine CenTer

The Brain and Spine CenTer The Br ain and Spine Center Choosing the right treatment partner is important for patients facing tumors involving the brain, spine or skull base. The Brain and Spine Center at The University of Texas

More information

Report series: General cancer information

Report series: General cancer information Fighting cancer with information Report series: General cancer information Eastern Cancer Registration and Information Centre ECRIC report series: General cancer information Cancer is a general term for

More information