GU cancer

Australian data shows rapid but variable uptake of hypofractionated RT

Uptake of hypofractionated radiation therapy for nonmetastatic prostate cancer has increased dramatically in recent years with no differences in patient-reported outcomes.

The increased uptake is consistent with 2018 international guidelines which achieved strong consensus for offering moderately hypofractionated RT across risk groups to patients choosing external beam radiation therapy.

In data from 6,368 patients in the Australian and New Zealand Prostate Cancer Outcomes Registry (PCOR-ANZ), 70.4% of men had long-course conventional radiation therapy (CRT) and 29.6% received moderate HRT between 2016 and 2019.

The use of hypofractionated radiation therapy increased from 2.1% in the first half of 2016 to 52.7% in the second half of 2019.

The study, published in JAMA Network Open, said the increased use was especially pronounced for intermediate-risk cancer patients.

“In later years, a more modest increase in use of hypofractionated RT for high-/very high–risk disease was observed (up to 42%), consistent with evolving guidelines in 2018 recommending HRT regardless of risk group, when not including elective pelvic nodes,” the study authors said.

However uptake of HRT varied between jurisdictions, institutions, clinicians and patient cohorts.

“Rapid adoption was apparent from 2017 for New Zealand whereas year-on-year increases in hypofractionated RT proportions of approximately 15% were seen in NSW/ACT and Victoria/Tasmania with lower proportions in Queensland and SA/NT.”

“Men commencing RT in 2018 had more than 3 times the odds of receiving HRT (OR, 3.04; 95% CI, 1.84-5.00) than those commencing RT in 2016, and those commencing RT in 2019 had more than 7 times the odds of receiving HRT in 2017 (OR, 7.18; 95% CI, 5.08-10.16) than those commencing HRT in 2016.

In patients reported outcomes, receipt of hypofractionated RT was associated with statistically significant but marginally higher scores in urinary irritation/obstruction, bowel function, and sexual function domains.

“No significant differences were seen in the urinary incontinence domain or in the urinary and bowel bother scores.”

The investigators, led by Associate Professor David Pryor from the Princess Alexandra Hospital in Brisbane, said the aim of registries such as PCOR-ANZ was to monitor patterns of care, outcomes, and variance as well as to use this information to reduce variations and disparities in care and improve outcomes.

“Our analysis has highlighted the importance of monitoring the implementation of evidence-based care into practice and provides further insight into the multiple potential factors behind this variation that may need to be addressed to optimise implementation strategies.”

“These real-world data also provide confirmation that high-quality PROs are being maintained as hypofractionation use increases across Australia and New Zealand.”

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