Intraoperative electron beam radiation-therapy for early breast cancer – bibliographic review and economic analysis

Abstract

Objectives: To compare local control and overall survival and perform an economic analysis between intraoperative electron beam radiation therapy (IOeRT) and conformal radiotherapy, directed to the whole breast (RT 3D), for the treatment of early breast cancer. Methods: A systematic review of the literature was performed, with the inclusion of 1 controlled randomized study, comparing IOeRT with standard treatment – RT 3D, in early breast cancer. Posteriorly, due to comparable results between the studied techniques, a cost-minimization analysis was executed. Results: There was a small increase in the number of local failures, in 5 years (4.4 vs. 0.4%), but with no changes in overall survival. When the analysis was restricted to women with tumors up to 2.0 cm, grades I or II, with negative axilla or with up to 3 compromised lymph nodes and with tumors not classified as triple-negative, a comparable level of local control was reached (1.5% over 5 years), without significant differences in treatment side effects. In the following economic analysis, a cost minimization study was chosen, once both treatments were equivalent, considering local control and overall survival. The perspective was that of the Brazilian private healthcare system, based on the costs of the procedures according to the Brazilian Hierarchical Classification of Medical Procedures (CBHPM), 5th edition. In this analysis, it was observed that the delivery of IOeRT implies a resource saving of 51.5% per treatment. Conclusion: We conclude that IOeRT is a very interesting option, that leads to resource savings, when used in the treatment of women with early breast cancer, observing the inclusion criteria previously described, in the Brazilian health care payer’s perspective.