Economic consequence of local control with radiotherapy: cost analysis of internal mammary and medial supraclavicular lymph node radiotherapy in breast cancer.

PURPOSE: To investigate the financial implications of radiotherapy (RT) to the internal mammary and medial supraclavicular lymph node chain (IM-MS) in postoperative breast cancer. METHODS AND MATERIALS: A cost-effectiveness and cost-utility analysis were performed, using Markov models, comparing the early and delayed costs and effects of IM-MS during a 20-year time span from a societal viewpoint. The outcome estimates were based on Level I evidence from postoperative RT literature and the cost estimates on the standard practice of the Leuven University Hospitals, with the RT costs derived from an activity-based costing program developed in the department. RESULTS: On the basis of the assumptions of the model and seen during a 20-year time span, primary treatment including IM-MS RT results in a cost savings (approximately 10,000) compared with a strategy without RT. Because IM-MS RT also results in better clinical effectiveness and greater quality of life, the treatment with IM-MS dominates the approach without IM-MS. Sensitivity analyses confirmed the robustness of these results in all tested circumstances. Although threshold values were found for the cost of IM-MS, the cost at relapse, and the quality of life after treatment, these were substantially different from the baseline estimates, indicating that it is very unlikely that omitting IM-MS would become superior. CONCLUSION: This ex-ante cost evaluation of IM-MS RT showed that the upfront costs of locoregional RT are easily compensated for by avoiding the costs of treating locoregional and distant relapse at a later stage. The cost-sparing effect of RT should, however, be evaluated for a sufficiently long time span and is most specifically found in tumors with a rather slow natural history and a multitude of available systemic treatments at relapse, such as breast cancer.

Short-course total lymphoid irradiation for refractory cardiac transplantation rejection.

BACKGROUND: Total lymphoid irradiation (TLI) has been used as an effective therapy for refractory allograft cardiac transplantation rejection. In this study we assessed our short-course TLI regimen for treatment of this condition. METHODS: A short course of TLI (4.5 Gy in 4 fractions) was given to 6 patients with recalcitrant allograft cardiac transplant rejection at the Royal Perth Hospital. RESULTS: Treatment compliance was excellent with most patients having no acute toxicity. With a median follow-up of 25 months, 83% of patients remain alive and disease-free. CONCLUSIONS: To date, no convincing evidence of radiation-related late effects have been documented with TLI. Nonetheless, larger scale trials are required for validation before this approach can be widely incorporated into the current transplantation (Tx) rejection regimen.