For TomoTherapy, GKS, and CKS, there was a lack of evidence from RCTs. Most of the studies evaluated GKS rather than CKS, and no studies evaluated TomoTherapy. This may reflect the fact that GKS is the oldest and perhaps more widely used technology. Most of the literature on TomoTherapy, GKS, and CKS were case series reports, which were outside the scope of this report because such studies do not allow for direct comparisons of clinical or costeffectiveness.
GKS was found to be clinically effective or to have produced similar benefits compared with other standard treatments (for example, WBRT) and conventional radiotherapy. The primary patient outcome measures in the included studies were typically tumour growth control or survival.
No cost-effectiveness analyses comparing TomoTherapy, GKS, and CKS were identified.
CKS and GKS were found to be more expensive than traditional SRS. They remained costeffective in specific situations and when compared with comparators other than TomoTherapy, GKS, or CKS. No economic studies on TomoTherapy were included. Given the current evidence, it is not possible to reliably estimate the comparative clinical effectiveness and cost-effectiveness of TomoTherapy, GKS, and CKS.