Abstract Book

S232

ESTRO 37

irradiation, in 1-8 treatment fractions. Its clinical use for treating lung nodules, starting from small peripheral lesions to larger tumors, and lately close to critical structures, progressively increased hand in hand with technology. Many international scientific societies and networks now consider SBRT as the first line non-surgical treatment option for medically inoperable patients affected with stage I NSCLC, and its indications are rapidly expanding also for lung metastases. SBRT has also been used for treating liver, adrenal, bone and lymph- nodal metastases, with the potential of combining systemic therapies with a multiple-site low-toxicity local therapy approach for oligometastatic patients. Retrospective and few prospective data are in favor of its use with potential benefit on survival, for example for lung and breast cancer, and a window of opportunity is open for the combination with immunomodulatory agents. Despite major advances and recognized clinical success, high-dose hypo-fractionated SRS-SBRT remains challenging for the whole radiation oncology team, for several reasons (choice of the best dose /fractionation schedule, motion control, planning optimisation, image guidance, etc.). Moreover, a lack of consolidated phase III clinical trials, for both the settings of early stage NSCLC and extra-cranial metastases, is regarded by many oncology specialists as an intrinsic limitation for the wide acceptance of SBRT. The aim of this lecture is to analyze and discuss the results of selected SRS and SBRT studies in light of the technological advances and the clinical needs emerged over the last years, with the aim of placing SRS and SBRT in the context of contemporary oncology and personalized medicine. SP-0444 Opportunities to enhance health and health care value in radiation oncology J. Bekelman 1 1 University of Pennsylvania, Philadelphia, USA Abstract text Research and innovation have led to measurable improvements in survival and quality of life for patients with cancer. Treatment now often resembles the management of chronic disease, incorporating both acute inpatient and longitudinal outpatient care. However, the delivery of cancer care is inherently multispecialty and multi-setting medical care that easily produces fragmentation, generating high costs and care variability. Opportunities to enhance health and health care value in radiation oncology depend on extent to which radiation oncologists are accountable for all care needs of the patient and total costs of care and can be fostered by payment and delivery system reform. Three principles can drive value in radiation oncology: First, payment systems should align provider incentives toward patient- centered, coordinated care among radiation oncologists, other specialists, and generalists. Second, payment systems should link to care quality or outcomes. Third, performance feedback on outcomes and costs, adjusted for case mix, should be provided to patients, providers, and payers, driving innovation and competition on health and health care value. Symposium: Value-based radiation oncology SP-0443 Defining international standardization of value in health care S. Myers ICHOM, USA Abstract not received

In this presentation, these principles will be outlined with examples, opportunities and challenges for radiation oncology that can be applied across national health care and payment systems in Europe and the United States. SP-0445 Towards value based radiation oncology in Europe Y. Lievens 1 1 Ghent University Hospital, Radiation Oncology, Ghent, Belgium Abstract text How to ascertain access to innovative treatment strategies in the context of rising healthcare costs and squeezed public finances, has been at the forefront of healthcare policy discussions over the last decades. The methodology of economic evaluation, estimating which extra clinical benefits can be gained from higher costs incurred, has since been the standard to assess the value for money of new interventions. But the perceived primary focus on cost shifting and cost reduction, have rendered health care providers and patients skeptical towards this approach. More recently, the emphasis has moved towards the benefit for the patients, with value in healthcare being defined as the best patient outcomes achieved per dollar expended. This requires a comprehensive assessment of the impact of new interventions on a whole spectrum of outcomes valued by the patient – which in addition to survival, toxicity and quality of life, also relate to the time and sustainability of health recovery – along with the costs across the entire cycle of care. Different tools, such as the magnitude of clinical benefit scale of ESMO and the ASCO value framework, only to name a few, have been developed to assess the value of innovation in oncology. But as was also the case for economic evaluations, they are most typically centered on new pharmaceuticals, with less attention paid to access to non-pharmaceutical innovations. Under the umbrella of the European CanCer Organisation and together with other stakeholders in European oncology and with patient representatives, ESTRO has initiated a project to address this imbalance, and help policy makers consider access and value more broadly across the entire cancer care spectrum. In this project, the existing methodologies for value-assessment primarily designed for the pharmaceutical market are assessed, the specific needs of radiotherapy and surgery in terms of outcome evaluated and the potential to develop a similar tool for non-pharmaceutical innovations addressed. In the presentation, the current status of the project, which has the ultimate aim to come to a harmonized approach to value-based health care across the different oncologic domains, will be discussed. SP-0446 Radiomics: What about harmonisation and standardisation? J. Kalpathy-Cramer 1 1 Harvard Medical School, Radiology, Boston, USA Abstract text Medical imaging is one of the largest sources of “Big Data” in the world and yet most of the data is in the form of large unstructured objects, making these data largely inaccessible. Radiomics, “the high-throughput extraction of large amounts of image features from radiographic images,” has been used to provide quantitative descriptors for the regions of interest that are the basis for the classification and prediction tasks in radiology and Symposium: Radiomics – Technical and clinical challenges and opportunities