Changing pattern of radiation therapy for bone metastases in an Australian population-based cohort of men with prostate cancer

Hypofractionation Utilisation in Radiation Therapy: A Regional Department Evaluation

INTRODUCTION

There has been an uptake in hypofractionation radiotherapy schedules (> 2.45 Gy per fraction) worldwide over the last decade. The aim of this paper was to evaluate the change in fractionation schedules for patients undergoing radiotherapy in regional Queensland. The influence of treatment site, intent and patient social circumstances was assessed, identifying any current gaps in practice.

METHODS

This retrospective clinical audit, included patients who underwent radiotherapy in 2012, 2019 and 2022 at a large regional department. This allowed a 10-year analysis and an evaluation of any impact of COVID-19. Demographic data and treatment information was collected and analysed using descriptive statistics.

RESULTS

There was a notable trend favouring hypofractionation for patients treated for breast and prostate cancer. In 2012, 62.7% of breast cancer patients were treated with conventional fractionation and 37.3% were treated with hypofractionation, versus 2.4% and 92.1%, respectively, in 2022. Prostate cancer fractionation changed from 99.4% of patients treated with conventional fractionation and 0.6% with hypofractionation in 2012 to 23.2% and 74.1%, respectively, in 2022. The standard of care also shifted for palliative intent, with lung, brain and bone metastases in 2022 being treated with increased hypofractionated and ultra-hypofractionated radiotherapy (> 5 Gy per fraction). This coincides with more complex and modulated treatments being readily available, such as stereotactic radiotherapy and volumetric modulated arc therapy. Hypofractionated treatments, however, were not influenced by the social factors of patients, having no distinct relationship with Indigenous status, age and patients' distance to treatment.

CONCLUSION

This study has validated the increase in hypofractionated treatments over a range of cancer sites and treatment intents, with increased treatment complexity. This has a direct impact on both departmental resources and patient-centred care, offering value-based radiotherapy.

Large variation in radiation therapy fractionation for multiple myeloma in Australia

AIM

To evaluate the patterns of use of different radiation therapy (RT) fractionation for multiple myeloma (MM) bone disease.

METHODS

This is a population-based cohort of patients with MM who had RT between 2012 and 2017 as captured in the statewide Victorian Radiotherapy Minimum Data Set in Australia. Data linkage was performed to identify subsets of RT delivered within 3 months of death. RT fractionation was classified into four groups: single-fraction (SFRT), 2-5, 6-10, and > 10 fractions. Changes in RT fractionation use over time were evaluated with the Cochran-Armitage test for trend. Factors associated with RT fractionation were evaluated using multivariate logistic regressions.

RESULTS

Nine hundred and sixty-seven courses of RT were delivered in 623 patients. The proportion of SFRT, 2-5, 6-10 and > 10 fractions RT was 18%, 47%, 28%, and 7%, respectively. There was an increase in the use of 2-5 fractions, from 48% in 2012 to 60% in 2017 (p-trend < .001), with corresponding decrease in the use of 6-10 fractions, from 26% in 2012 to 20% in 2017 (p-trend = .003). Nine percent (40/430) of RT courses at private institutions were SFRT, compared to 25% (135/537) in public institutions (p < .001). In multivariate analyses, treatment in private institution was the strongest predictor of multifraction RT use. SFRT use was more common closer to the end of life-18%, 14%, and 33% of RT within 2-3, 1-2, < 1 month of death, respectively.

CONCLUSION

There is increasing use of shorter course RT (2-5 fractions) for MM over time. SFRT use remains low, with large variation in practice.