The Pattern of Use of Hypofractionated Radiation Therapy for Early Stage Breast Cancer in New South Wales, Australia, 2008-2012

Publication date: Available online 24 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Geoff P. Delaney, Senthilkumar Gandhidasan, Richard Walton, Frances Terlich, Deborah Baker, David Currow
PurposeIncreasing Phase III evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early-stage, node-negative breast cancer. However, uptake of hypofractionation has not been universal. The aim of this study was to investigate the hypofractionation regimen variations in practice across public radiation oncology facilities in NSW.Methods and MaterialsPatients with early breast cancer registered in the NSW Clinical Cancer Registry that received radiotherapy treatment for early stage breast cancer in a publicly-funded radiotherapy department between 2008 and 2012 were identified. Data extracted and analysed included dose and fractionation type, patient age at first fraction, address (for geo-coding), year of diagnosis, year of treatment, laterality and, department of treatment. A logistic regression model was used to identify factors associated with fractionation typeResultsOf the 5880 patients fulfilling the study criteria, 3209 patients (55%) had standard fractionation and 2671 patients (45%) received hypofractionation Overall, the use of hypofractionation increased from 37% in 2008 to 48% in 2012 (range = 7-94% across departments). Treatment facility and the radiation oncologist prescribing the treatment were the strongest independent predictors of hypofractionation. Weaker associations were also found for age, tumor site laterality, year of treatment, and distance to facility.ConclusionsHypofractionated regimens of whole-breast radiation therapy have been variably administered in the adjuvant setting in NSW despite the publication of long-term trial results and consensus guidelines. Some factors that predict the use of hypofractionation are not based on guideline recommendations, including lower rates of left-sided treatment and increasing distance from a treatment facility.

Teaser

A retrospective audit of early stage breast cancer patients treated with radiotherapy in New South Wales (NSW) departments 2008-2012 was performed using NSW Clinical Cancer Registry data. The use of hypofractionation is rising but still lower, at 45%, than would be expected based on treatment guidelines. Factors that correlated significantly with hypofractionation use were age, laterality, year, distance of patient residence from the department, treating facility and radiation oncologist.


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