Bhatia Rohini K, Grieb Suzanne M, Rendle Katharine A, Ngwa Wilfred, Grover Surbhi
Department of Radiation Oncology, Emory University, Atlanta, GA.
Department of Pediatrics Center for Child and Community Health Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Adv Radiat Oncol. 2024 Nov 15;10(2):101683. doi: 10.1016/j.adro.2024.101683. eCollection 2025 Feb.
In prostate and breast cancer, moderate hypofractionation (HF) has demonstrated comparable, if not greater, efficacy than conventional fractionation. There is a stark disparity in the uptake of HF between North America and Africa. Using the Consolidative Framework for Implementation Research, we evaluated barriers and facilitators for implementing HF in Sub-Saharan Africa (SSA).
Radiation oncologists and medical physicists working in SSA were recruited via the AORTIC Radiation Oncology Special Interest Group and subsequent snowball sampling. Interviews were conducted virtually between November 2022 and January 2023. Transcripts were analyzed using directed content analysis guided by a Consolidative Framework for Implementation of research interview domains and constructs.
In total, 19 interviewees (17 radiation oncologists and 2 medical physicists) from 11 SSA countries participated, of which 94% noted the use of HF (40.05 Gy/15fx or 42.67 Gy/16fx) in breast cancer clinics and 38% in prostate cancer clinics (60-66 Gy/20fx). While nearly all participants identified the benefits of HF for both clinics and patients, many also noted that the lack of long-term data within an African population created discomfort in using HF. Many participants believed in the utility of HF but expressed a lack of confidence in its use caused by uncertainty about the safety of the technique, especially in centers with cobalt or 3-dimensional conformal radiation therapy-only capabilities. In breast HF, participants expressed concern regarding breast size and ideal eligibility criteria for patients. In prostate HF, on-treatment imaging and lack of fiducials were identified as barriers. Key facilitators in adopting HF included hands-on training, partnerships with disease-site-specific individuals with HF experience, and consensus on patient eligibility and technique requirements.
HF is regarded as a valuable tool for breast and prostate cancer in SSA, and breast HF is widely used. Attention to the use of 3-dimensional conformal radiation therapy with HF, long-term toxicity data in African populations, and training sessions may facilitate further use of HF for prostate cancer.
在前列腺癌和乳腺癌中，适度的大分割放疗（HF）已显示出与传统分割放疗相当甚至更高的疗效。北美和非洲在大分割放疗的应用方面存在明显差异。我们使用实施研究的整合框架，评估了在撒哈拉以南非洲（SSA）实施大分割放疗的障碍和促进因素。
通过主动脉放射肿瘤学特别兴趣小组及后续的滚雪球抽样，招募了在SSA工作的放射肿瘤学家和医学物理学家。2022年11月至2023年1月期间进行了虚拟访谈。使用由实施研究访谈领域和结构的整合框架指导的定向内容分析法对访谈记录进行分析。
来自11个SSA国家的19名受访者（17名放射肿瘤学家和2名医学物理学家）参与了研究，其中94%指出在乳腺癌诊所使用大分割放疗（40.05 Gy/15次分割或42.67 Gy/16次分割），38%在前列腺癌诊所使用（60 - 66 Gy/20次分割）。虽然几乎所有参与者都认同大分割放疗对诊所和患者的益处，但许多人也指出，非洲人群缺乏长期数据使得使用大分割放疗时感到不安。许多参与者相信大分割放疗的效用，但由于对该技术安全性的不确定性，尤其是在仅具备钴或三维适形放疗能力的中心，他们对其使用缺乏信心。在乳腺癌大分割放疗中，参与者对乳房大小和患者的理想入选标准表示担忧。在前列腺癌大分割放疗中，治疗期间成像和缺乏基准点被视为障碍。采用大分割放疗的关键促进因素包括实践培训、与有大分割放疗经验的特定疾病领域个体建立伙伴关系，以及就患者入选标准和技术要求达成共识。
大分割放疗被视为SSA地区乳腺癌和前列腺癌的一种有价值的工具，并且乳腺癌大分割放疗被广泛使用。关注大分割放疗与三维适形放疗的联合使用、非洲人群的长期毒性数据以及培训课程，可能会促进大分割放疗在前列腺癌中的进一步应用。
