Study indicates radiotherapy for SUS that treats lung cancer in up to 5 sessions

A study that will be published in the October issue of The Lancet Regional Health – Americas proposes to replace classical radiotherapy with an advanced technique, SBRT (Stereotactic Body Radiation Therapy, or stereotactic body radiotherapy) to treat a certain type of lung cancer in the network. public health.

Researchers concluded that, while expensive, SBRT is a more cost-effective strategy than conventional fractionated radiation therapy (CFRT) for early-stage non-small cell lung cancer, which accounts for between 80% and 85% of cases. .

The procedure is not listed by the ANS (National Supplementary Health Agency) nor is it recognized by the SUS, but about 20% of private services and 10% of public services in the country have it. There are no refunds for anyone who goes through it.

The equipment costs around US$ 7 million (approximately R$ 36 million). The monthly preventive maintenance is R$ 100 thousand.

The Brazilian public health system does not finance the use of SBRT for two reasons: the amount is high and there is no cost-effectiveness analysis that demonstrates the benefit of the technique — the objective of this study.

“Today, the standard curative treatment is lobectomy — the removal of a lung lobe. The problem is that most of those who discover the tumor at an early stage are those who smoke, the elderly and those who have a weak heart or other smoking-related diseases. , life and age”, explains one of the study’s coordinators, radio-oncologist Alexandre Arthur Jacinto, from the Oncological Radiotherapy Department at Hospital de Amor (formerly Barretos Cancer Hospital) and director of teaching and research at the Brazilian Society of Radiotherapy.

SBRT acts only on the nodule and protects any surrounding tissue, using a technique based on 4D tomography.

“While we breathe and talk, the lung moves and the nodule too. How do I precisely treat a region that moves all the time? Stereotaxis treats this tumor by tracking its movement. I see the movement of the nodule and I can give a giant dose of radiotherapy with the possibility of controlling this nodule of 90%, which is the same that surgery offers”, explains the specialist.

In classic low-dose radiotherapy, the patient undergoes 30 sessions in six weeks. Currently, the value of the SUS table for this treatment in the lung is around R$ 3,600.

At SBRT, up to five applications are carried out. An Australian study carried out with 101 patients had compared the two techniques and proved that the most modern technology increases survival and offers disease control around 90%, without having to remove any part of the lung.

“It is only on the outside, a bath of light. Currently, in some cases, we can do this treatment in just one application”, says the oncologist.

To reach a conclusion on the cost-effectiveness of SBRT for the SUS, the researchers analyzed a group of men aged 75 years, who discovered early lung cancer but inoperable due to lack of clinical conditions. Costs were based on SUS reimbursement values ​​and simulated in the private sector.

“We modeled the cost of each step and how much it would cost the government or supplementary health to pay for each procedure in cases where the disease returned. Although the patient generates costs in any modality, the difference is great when using SBRT, progressively favoring over time. Even if the SUS spent R$ 25 thousand at once with the patient, it would save resources”, says Jacinto, explaining that with conventional radiotherapy, the expense with CT scans, procedures, hospitalizations and therapies would be greater.

He points out that the study did not take into account the costs of transport, food and the inconvenience of the patient’s and family’s life. “Social impact can be calculated more robustly,” he explains.

The data suggest that, using a threshold of BRL 25,000 per patient, SBRT was more cost-effective than classical radiation therapy for non-small cell lung cancer in a public health system in an upper-middle-income country. , like Brazil.

SBRT can also be used in the treatment of other cancers, such as prostate, lung metastasis, colon and spine cancer.

The Brazilian Society of Radiotherapy intends to submit the study to analysis by Conitec (National Commission for the Incorporation of Technologies in the Unified Health System) for possible incorporation into the SUS.

The study was funded by Varian Medical Systems, a maker of radiotherapy equipment.

In addition to the radio-oncologist Alexandre Arthur Jacinto, the researchers Gustavo Viani Arruda, from the Department of Medical Imaging, Hematology and Clinical Oncology at the USP School of Medicine of Ribeirão Preto, Marina Lourenção and Jorge Henrique Caldeira de Oliveira, both from the of Economics, Administration and Accounting from USP in Ribeirão Preto, and Júlia Simoes Correa Galendi, from the University of Cologne, Germany.

Data from the Inca (National Cancer Institute) point to lung cancer as the third most common among men and the fifth most common among women. The year 2022 is expected to close with estimates of 30,200 new cases, with 17,760 among men and 12,440 among women.