Health Technology Wales, Cardiff, UK.
Department of Colorectal Surgery, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK.
Colorectal Dis. 2024 May;26(5):1053-1058. doi: 10.1111/codi.16935. Epub 2024 Mar 11.
Health Technology Wales sought to evaluate the clinical and cost-effectiveness of contact X-ray brachytherapy (CXB) for early-stage rectal cancer.
Relevant studies were identified through systematic searches of MEDLINE, Embase, Cochrane Library and Scopus. A cost-utility model was developed to estimate the cost-effectiveness of CXB in National Health Service Wales, using results of the Organ Preservation in Early Rectal Adenocarcinoma (OPERA) trial. Patient perspectives were obtained through the Papillon Patient Support group and All-Wales Cancer Network.
The OPERA randomized controlled trial showed that CXB improved complete response and organ preservation rates compared with external-beam boost for people with T2-3b, N0-1, M0 rectal cancer who are fit for surgery. Managing more of this population non-operatively after CXB was estimated to provide 0.2 quality-adjusted life years at an additional cost of £887 per person. CXB was cost effective compared with external-beam boost at a cost of £4463 per quality-adjusted life year gained. This conclusion did not change in scenario analysis and CXB was cost effective in 91% of probabilistic sensitivity analyses. Patients valued receiving clear information on all available options to support their individual treatment choices. The detrimental impact of a stoma on quality of life led some patients to reject the idea that surgery was their only option.
This evidence review and cost-utility analysis indicates that CXB is likely to be clinically and cost effective, as part of a watch and wait strategy for adults fit for surgery. Wider access to CXB is supported by patient testimonies.
威尔士健康技术评估机构旨在评估接触式 X 射线近距离放射治疗（CXB）治疗早期直肠癌的临床疗效和成本效益。
通过系统检索 MEDLINE、Embase、Cochrane 图书馆和 Scopus，确定了相关研究。使用 Organ Preservation in Early Rectal Adenocarcinoma（OPERA）试验的结果，为威尔士国民保健服务开发了一种成本效用模型，以估计 CXB 的成本效益。通过 Papillon 患者支持组织和全威尔士癌症网络获取患者的观点。
OPERA 随机对照试验表明，与外照射加量相比，CXB 提高了 T2-3b、N0-1、M0 期适合手术的直肠腺癌患者的完全缓解率和器官保留率。估计对更多接受 CXB 治疗后不进行手术的患者进行非手术管理，将额外增加每人 887 英镑的成本，但可获得 0.2 个质量调整生命年。与外照射加量相比，CXB 的成本效益为每获得 1 个质量调整生命年节省 4463 英镑。这一结论在情景分析中没有改变，在 91%的概率敏感性分析中，CXB 是具有成本效益的。患者希望获得所有可用选择的明确信息，以支持他们的个人治疗选择。造口对生活质量的不利影响使一些患者拒绝将手术作为唯一选择的想法。
本证据综述和成本效用分析表明，CXB 作为适合手术的成年人的观察和等待策略的一部分，可能具有临床疗效和成本效益。患者的证词支持更广泛地使用 CXB。
