Recent evidence shows the non-inferiority of hypofractionated radiation therapy regimens compared to conventional regimens in the treatment of prostate cancer (PCa). Hypofractionation has benefits for both the patient and healthcare system, due to the shorter treatment duration. Despite this, the uptake of hypofractionation can be slow. Here we investigate the factors influencing the changing utilisation of moderate hypofractionation (HypoRT) for the treatment of PCa.
We conducted a population-based, retrospective, consecutive cohort study using the 2014-18 Outpatient Radiation Oncology Data from public and private treatment facilities in New South Wales, Australia. Included participants had a PCa diagnosis of any risk and completed curative-intent external beam radiotherapy without treatment to lymph nodes. Factors potentially affecting use of HypoRT were examined using a 3-level hierarchical logistic regression model. The effects were reported using adjusted, median or interval odds ratios.
There were 4915 patients included in the study. Of these, 4053 (82.5%) received conventional fractionation and 862 (17.5%) received HypoRT. HypoRT utilisation increased from 5.2% (2014) to 40.3% (2018). The treating radiation oncologist, treatment facility and increasing distance to treatment centres had the greatest influence on HypoRT uptake. The main limitation was the lack of stratification by PCa risk categorisation.
Though HypoRT uptake has considerably increased between 2014 and 2018, it remains variable between facilities and treating radiation oncologists. Strategies are being explored to reduce inter-clinician variability.

Copyright © 2021. Published by Elsevier Inc.

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