Cost-benefit analysis of 3D conformal radiation therapy

The potential of 3D conformal radiation therapy to improve the efficacy of radiotherapy is one of the most important technical advances in recent years. The potential benefit of improved local control from dose escalation must be weighed against the potential cost of increased complications to normal tissue.

We evaluated the cost-benefit of 3D conformal radiation therapy in terms of the benefit to tumor cure weighed against the cost of complications to normal tissue. Assessment of current data shows that problems remain in adequately defining variables that contribute to both the tumor cure probability (benefit) and normal tissue complication probability (cost). For tumor cure probability, identifying the dose escalation needed for cure for the most tumor sites as well as precisely defining tumor volume remain problematic. For normal tissue complication probability, inadequate clinical data on toxicity to normal tissue for different tumor sites continue to make it difficult to use methods that estimate complications, such as dose-volume histograms as proposed by Lyman, to the clinical setting.

3D conformal radiation therapy is a promising new technology that may substantially improve the efficacy of radiation therapy. More clinical research, however, is needed to recognize the costs and benefits of this new technology: 1. Tumor control probability: More information is needed on the accurate definition of the target volume as well as on the amount of radiation necessary to cure different tumor sites. 2. Normal tissue complication probability: Methods for determining toxicity to normal tissue are needed. Current calculations based on various models are insufficient.