Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
German Cancer Research Consortium, Core Site Heidelberg, German Cancer Research Center, Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine and Heidelberg University Hospital, Heidelberg, Germany.
Radiother Oncol. 2021 Apr;157:32-39. doi: 10.1016/j.radonc.2021.01.003. Epub 2021 Jan 14.
Multiple large trials have established the non-inferiority of hypofractionated radiotherapy compared to conventional fractionation. This study will determine real-world hypofractionation adoption across different geographic regions for breast, prostate, cervical cancer, and bone metastases, and identify barriers and facilitators to its use.
An anonymous, electronic survey was distributed from January 2018 through January 2019 to radiation oncologists through the ESTRO-GIRO initiative. Predictors of hypofractionation were identified in univariable and multivariable regression analyses.
2316 radiation oncologists responded. Hypofractionation was preferred in node-negative breast cancer following lumpectomy (82·2% vs. 46·7% for node-positive; p < 0.001), and in low- and intermediate-risk prostate cancer (57·5% and 54·5%, respectively, versus 41·2% for high-risk (p < 0.001)). Hypofractionation was used in 32·3% of cervix cases in Africa, but <10% in other regions (p < 0.001). For palliative indications, hypofractionation was preferred by the majority of respondents. Lack of long-term data and concerns about local control and toxicity were the most commonly cited barriers. In adjusted analyses, hypofractionation was least common for curative indications amongst low- and lower-middle-income countries, Asia-Pacific, female respondents, small catchment areas, and in centres without access to intensity modulated radiotherapy.
Significant variation was observed in hypofractionation across curative indications and between regions, with greater concordance in palliation. Using inadequate fractionation schedules may impede the delivery of affordable and accessible radiotherapy. Greater regionally-targeted and disease-specific education on evidence-based fractionation schedules is needed to improve utilization, along with best-case examples addressing practice barriers and supporting policy reform.
多项大型试验已经证实，与常规分割相比，低分割放射治疗具有非劣效性。本研究将确定不同地理区域内乳腺癌、前列腺癌、宫颈癌和骨转移瘤的低分割实际应用情况，并确定其应用的障碍和促进因素。
2018 年 1 月至 2019 年 1 月，通过 ESTRO-GIRO 倡议，以匿名电子调查的形式向放射肿瘤学家发放问卷。在单变量和多变量回归分析中确定低分割的预测因素。
2316 名放射肿瘤学家做出了回应。在保乳术后淋巴结阴性乳腺癌中，低分割（82.2% vs. 46.7%，淋巴结阳性；p<0.001）和低危/中危前列腺癌（57.5%和 54.5%，分别为高危（p<0.001））中更受欢迎。在非洲，32.3%的宫颈癌病例采用了低分割，而其他地区的比例<10%（p<0.001）。对于姑息治疗指征，大多数受访者都倾向于采用低分割。缺乏长期数据以及对局部控制和毒性的担忧是最常被提及的障碍。在调整后的分析中，对于低/中下收入国家、亚太地区、女性受访者、小覆盖范围以及没有调强放疗的中心，低分割在根治性治疗指征中最为少见。
在根治性治疗指征和地区之间，低分割的应用存在显著差异，姑息治疗的一致性更高。采用不适当的分割方案可能会阻碍提供负担得起和可获得的放射治疗。需要在区域范围内有针对性地进行针对特定疾病的基于证据的分割方案教育，以提高利用率，并提供最佳实践范例来解决实践障碍并支持政策改革。
