Population-Level Uptake of Moderately Hypofractionated Definitive Radiation Therapy in the Treatment of Prostate Cancer

Nithiyananthan, Kajanan; Creighton, Nicola; Currow, David C.; Martin, Jarad

doi:10.1016/j.ijrobp.2021.04.033

Cited by 6 publications

(9 citation statements)

References 24 publications

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“…Similar findings have been seen in American and Canadian studies 23 . Within Australia, a funding model which renumerates on a per fraction basis has been felt to slow implementation of prostate hypofractionation 38 . The ESTRO survey, however, found that when clinicians are surveyed, only 6–12% report that reimbursement is a barrier 47 …”

Section: Barriers To the Implementation Of Hypofractionationmentioning

confidence: 55%

“…Similarly for prostate cancer, a recent consecutive cohort study from NSW of patients receiving prostate radiation (not including lymph nodes) found that overall 17.5% of patients received hypofractionated treatment, increasing from 5.2% in 2014 to 40.3% in 2018 38 . Uptake by centre and clinician were highly variable, with centres varying from 0% to 95% in 2018 and variability between clinics from rates of 0–100% 38 . Perhaps this study indicated that lessons were learned from the slow adoption of hypofractionated breast treatments.…”

Section: Adoption Of Hypofractionationmentioning

confidence: 99%

“…38 Uptake by centre and clinician were highly variable, with centres varying from 0% to 95% in 2018 and variability between clinics from rates of 0-100%. 38 Perhaps this study indicated that lessons were learned from the slow adoption of hypofractionated breast treatments. Three major prostate hypofractionation trials were published between 2016 and 2018 [39][40][41] showing non-inferiority and the NSW cohort study found that this had already impacted practice by 2018.…”

Section: Palliativementioning

confidence: 99%

“…Three major prostate hypofractionation trials were published between 2016 and 2018 [39][40][41] showing non-inferiority and the NSW cohort study found that this had already impacted practice by 2018. 38 A report by the Prostate Cancer Outcomes Registry -Australia and New Zealand showed that the adoption of hypofractionation rose steadily from almost zero in 2016 to 42% in 2019. 42 In bladder cancer, a recent FROGG patterns of practice survey identified significant variations in clinical practice from participating institutions across Australia and New Zealand.…”

Section: Palliativementioning

confidence: 99%

“…23 Within Australia, a funding model which renumerates on a per fraction basis has been felt to slow implementation of prostate hypofractionation. 38 The ESTRO survey, however, found that when clinicians are surveyed, only 6-12% report that reimbursement is a barrier. 47 All of these concerns have led to variable adoption of hypofractionated techniques despite a robust evidence base, which in turn has led to unwarranted variation.…”

Section: Financialmentioning

confidence: 99%

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Unwarranted variation in radiation therapy fractionation

Batumalai

James

2022

J Med Imag Rad Onc

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The adoption of hypofractionation across multiple tumour sites has been slow despite robust evidence. There is considerable unwarranted variation in practice, both within and between jurisdictions. This has been attributed to inconsistencies in guidelines, physician preference, lack of technology and differing financial incentives. Unwarranted variation in the use of hypofractionation has a tremendous effect on cost to both patients and the healthcare system. This places an unnecessary burden on patients and poorly utilises scarce healthcare resources. A collaborative effort from clinicians, patients, healthcare providers and policymakers is needed to reduce unwarranted variation in practice. This will improve quality of care both for patients and at broader healthcare system level.

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Section: Barriers To the Implementation Of Hypofractionationmentioning

confidence: 55%

Section: Adoption Of Hypofractionationmentioning

confidence: 99%

Section: Palliativementioning

confidence: 99%

Section: Palliativementioning

confidence: 99%

Section: Financialmentioning

confidence: 99%

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Unwarranted variation in radiation therapy fractionation

Batumalai

James

2022

J Med Imag Rad Onc

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Hyaluronic Acid Spacer for Hypofractionated Prostate Radiation Therapy

et al. 2023

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ImportanceHypofractionated radiation therapy (RT) for prostate cancer has been associated with greater acute grade 2 gastrointestinal (GI) toxic effects compared with conventionally fractionated RT.ObjectiveTo evaluate whether a hyaluronic acid rectal spacer could (1) improve rectal dosimetry and (2) affect acute grade 2 or higher GI toxic effects for hypofractionated RT.Design, Setting, and ParticipantsThis randomized clinical trial was conducted from March 2020 to June 2021 among 12 centers within the US, Australia, and Spain, with a 6-month follow-up. Adult patients with biopsy-proven, T1 to T2 prostate cancer with a Gleason score 7 or less and prostate-specific antigen level of 20 ng/mL or less (to convert to μg/L, multiply by 1) were blinded to the treatment arms. Of the 260 consented patients, 201 patients (77.3%) were randomized (2:1) to the presence or absence of the spacer. Patients were stratified by intended 4-month androgen deprivation therapy use and erectile quality.Main Outcomes and MeasuresFor the primary outcome, we hypothesized that more than 70% of patients in the spacer group would achieve a 25% or greater reduction in the rectal volume receiving 54 Gy (V54). For the secondary outcome, we hypothesized that the spacer group would have noninferior acute (within 3 months) grade 2 or higher GI toxic effects compared with the control group, with a margin of 10%.ResultsOf the 201 randomized patients, 8 (4.0%) were Asian, 26 (12.9%) Black, 42 (20.9%) Hispanic or Latino, and 153 (76.1%) White; the mean (SD) age for the spacer group was 68.6 (7.2) years and 68.4 (7.3) years for the control group. For the primary outcome, 131 of 133 (98.5%; 95% CI, 94.7%-99.8%) patients in the spacer group experienced a 25% or greater reduction in rectum V54, which was greater than the minimally acceptable 70% (P &lt; .001). The mean (SD) reduction was 85.0% (20.9%). For the secondary outcome, 4 of 136 patients (2.9%) in the spacer group and 9 of 65 patients (13.8%) in the control group experienced acute grade 2 or higher GI toxic effects (difference, −10.9%; 95% 1-sided upper confidence limit, −3.5; P = .01).Conclusions and RelevanceThe trial results suggest that rectal spacing with hyaluronic acid improved rectal dosimetry and reduced acute grade 2 or higher GI toxic effects. Rectal spacing should potentially be considered for minimizing the risk of acute grade 2 or higher toxic effects for hypofractionated RT.Trial RegistrationClinicalTrials.gov Identifier: NCT04189913

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