S1395
Interdisciplinary - Health economics & health services research
ESTRO 2026
1 Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. 2 Institute of Public Health Policies (IPSUSS), Facultad de medicina y ciencias Universidad San Sebastián, Santiago, Chile. 3 Center for Cancer Prevention and Control (CECAN), Pontificia Universidad Católica de Chile, Santiago, Chile Purpose/Objective: Prostate cancer is among the most common malignancies in men, and radiotherapy (RT)—external- beam RT (EBRT) and/or brachytherapy—remains central across definitive, postoperative, and palliative settings. For rational and equitable planning, the optimal radiotherapy utilization rate (ORUR)—the proportion of patients who should receive RT at least once during the disease course according to evidence- based indications—is a key benchmark. This scoping review synthesizes contemporary ORUR estimates for prostate cancer across countries and modeling frameworks. Material/Methods: We followed PRISMA-ScR in a streamlined manner. Records were screened in duplicate and disagreements resolved by consensus. Identification: 1,406 records from databases plus 3 from other sources. Screening: 1,409 titles/abstracts. Full-text eligibility: 39 + 3 reports assessed. Included: 4 + 3 studies (four quantitative sources informing ORUR and three complementary/synthesis sources). We included studies that estimated ORUR using guideline-driven decision trees (EBEST/CCORE), ESTRO-HERO modeling (OUP/AUP), or criterion-based benchmarking (CBB). Studies reporting only observed use (TUR) without an optimal benchmark were excluded. From each study we extracted country/region, modeling framework, incidence period, ORUR (%), and key assumptions (age/comorbidity adjustment; EBRT-only vs any RT including brachytherapy). The protocol was registered on the Open Science Framework https://doi.org/10.17605/OSF.IO/QB67A Results: Across high-income settings, ORUR clustered near 60%. In Australia (New South Wales, 2010–2014), an age- and comorbidity-adjusted CCORE model estimated ORUR 61.7%, incorporating ≥ 80-year-olds and comorbidity indices. In Canada (Alberta, 2004– 2008), an EBEST + CBB analysis yielded ORUR 69.6%. Belgium (2009–2010) reported ≈ 62% using ESTRO- HERO (AUP vs OUP). In a middle-income context, Indonesia (2019) applied HERO-adapted + GLOBOCAN modeling and estimated ORUR 41% (range 28–66%), showing how demographic structure and competing- risk assumptions can lower eligibility. A review focused on aging described ORUR variability of ~44–62%, consistent with age/comorbidity effects. National registry linkage in Portugal (2015–2019) reported
ORUR 59% using HERO. Foundational CCORE decision- tree work (baseline 2003–2005) converged around 61%, aligning with contemporary estimates. In guideline-based modeling, EBRT-only ORUR is ~58% (54–64%), and any RT (EBRT±brachytherapy) ~60% (56– 66%), with brachytherapy contributing roughly ~10% depending on practice. Conclusion: Despite methodological differences, modern models consistently position prostate ORUR around 58–62% in high-income settings, with wider or lower ranges when adapting to middle-income contexts or applying stronger age/comorbidity adjustments. These benchmarks—rooted in EBEST/CCORE and ESTRO- HERO—should guide RT capacity planning for EBRT and brachytherapy, scenario analyses in aging populations, and evidence-informed allocation of resources in prostate radiotherapy
References: Mackenzie P, et al. Radiother Oncol. 2023;188:109862. Lievens Y, et al. Radiother Oncol. 2016;119:5–11. Jayalie VF, et al. J Cancer Policy. 2025;43:100522. Thompson SR, et al. Radiother Oncol. 2016;118:118– 121. Borras JM, et al. Radiother Oncol. 2016;119:5–11. Keywords: Prostate cancer, radiotherapy utilization, ORUR
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