Abstract
PRIMARY TRACK
Evidence generation and synthesis
SECONDARY TRACK
Other evidence generation and synthesis
BACKGROUND (INTRODUCTION)
Big-ticket technologies have been introduced in the health-care systems and are assumed as treatments of choice, especially in cancer. In the case of radiation therapy, treatments have significantly changed in the last decades due to the inclusion of more sophisticated image technologies. New planning systems had allowed integration of PET and CT data. Nevertheless, it remains unresolved the effectiveness of the use of embedded image in treatment planning, and the existence of Clinical Practice Guidelines is scarce.
LEARNING OBJECTIVES (TRAINING GOALS)
To analyze the role of PET-CT in planning radiotherapy treatments. To map the existence of technical guidance for its use in hospitals that have implemented the technology in Spain.
METHODS
We performed a comprehensive review (overview) for use of PET-CT in planning radiotherapy treatments. The databases consulted were MEDLINE, EMBASE, LILACS, Cochrane, CRD, and NGC, and the websites of societies ACR, AERO, ASTRO, ESGO, ESMO, ESTRO, IARC, ISRO, and SFOR. The limits were: human subjects, 1995-2009 (April). The studies included were RCTs, meta-analysis and systematic reviews, and prospective observational studies which included adult patients who had undergone radiotherapy treatment planning with PET-CT. We sent a survey to those hospitals that reported the use of the technology in Spain.
RESULTS
Thirty-eight documents out of 510 met inclusion criteria. The largest number of documents related to head-neck (13 documents) and lung cancers (12 documents). The reported outcomes were mainly surrogate with short follow-up periods. The quality of the evidence was medium or low. Only two guides or standards included planning with PET-CT. No results on morbidity or mortality were conclusive. The questionnaire showed that although hospitals had implemented the technique lacked a planning guide for the indication of PET-CT.
DISCUSSION (CONCLUSION)
The present study showed that big-ticket technologies, although sophisticated, have a lack of clinical guidance. It is thus necessary to develop and implement evidence-based recommendations.
TARGET AUDIENCE(S)
Clinical researcher Guideline developer Developer of guideline-based products Quality improvement manager/facilitator Health care policy analyst/policymaker Health insurance payers and purchasers Medical providers and executives Consumers' and patients' representatives