Estimation of an optimal radiotherapy utilization rate for gynecologic carcinoma - Part II - Carcinoma of the endometrium

BACKGROUND. Radiotherapy utilization rates for cancer vary widely, both within and between countries. Current estimates of the proportion of cancer patients who should optimally receive radiotherapy are based either on expert opinion or on the measurement of actual utilization rates, rather than on the best scientific evidence. METHODS. Evidence-based treatment guidelines regarding endometrial carcinoma were reviewed to develop an evidence-based benchmark for radiotherapy utilization. An optimal radiotherapy utilization tree was constructed and the proportions of endometrial carcinoma patients with clinical indications for radiotherapy were obtained from epidemiologic data. The ideal utilization rates were compared with actual radiotherapy utilization rates for endometrial carcinoma both in Australia and internationally. RESULTS. According to the best available evidence, radiotherapy is indicated at least once in 46% of all patients with endometrial carcinoma. A review of the limited data available concerning actual radiotherapy utilization rates revealed that the actual rates are approximately 10% lower than the optimal rates. CONCLUSIONS. Further research into the patterns of actual treatment and the development of optimal chemotherapy and surgery utilization rates for endometrial carcinoma is recommended. The difference between the optimal and the actual utilization rates warrants investigation into the reasons for the low radiotherapy utilization rates encountered in clinical practice. Cancer 2004;101:682-92. (C) 2004 American Cancer Society.