Breast Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_3_3345 - Uptake of whole breast hypofractionation: a rapid review of the literature

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Uptake of whole breast hypofractionation: a rapid review of the literature
M. Culbert1, J. F. De Los Santos2, A. I. Saito3, and A. S. Wallace2; 1University of Missouri, Columbia, MO, 2University of Alabama at Birmingham, Birmingham, AL, 3Division of Radiation Oncology, Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan

Purpose/Objective(s): Radiation oncology guidelines favor hypofractionated whole breast irradiation (HF-WBI) following breast conserving surgery over more conventional fractionation schemes, but adoption varies worldwide. The purpose of this study is to assess uptake of HF-WFT systematically.

Materials/Methods: Rapid Review of literature published between 1/2008 and 12/2017 were performed using standardized guidelines. Primary databases used were PubMed and Embase. Citation tracking methods were also incorporated. Subject heading and index term searches utilized a combination of the following key words: hypofractionation, fractionation, dose, breast, radiotherapy, radiation, irradiation, neoplasms, breast neoplasm, practice patterns, utilization, standards, quality of health care, economics, adoption, quality, cost, practice, and guideline. Categorization of manuscripts was performed using Rayyan. Papers were included if they reported results of uptake in > 1 institution. Additionally, studies reporting physician practice patters were also included, as were references noted in relevant articles. Papers from single institution experiences, or reporting results of clinical trials, and clinical outcomes were excluded.

Results: 832 publications were reviewed, 32 of which met inclusion criteria. The included studies originated from Australia, Canada, France, Italy, New Zealand, Pakistan, Spain, Taiwan, United Kingdom, and the United States. Countries with the highest overall adoption include the United Kingdom, Taiwan, Italy, and Canada with 87%, 77%, 76%, and 75% of eligible patients receiving HF-WBI between 2010 and 2015 respectively (Table 1). The country with the lowest adoption was Spain with 29% of eligible patients receiving HF-WBI in 2015. In contrast, the United Kingdom and Canada had the highest rate (50%, 66%) of early adoption of HF-WBI by 2003. In the United States, eligible patients receiving HF-WBI increased from 4-7% to 33-49% between 2004 and 2014. Studies (n=5) reported on surveys of physician practice patterns, in the following countries: Australia, Italy, New Zealand, and the United States. The largest barriers noted in these studies were size of practice, institutional historical bias by practitioners, practitioner interpretations of the literature, and lack of resources.
Country Sample Size Facilities Surveys Highest Reported % Hypofractionation
Australia/New Zealand 5880 192 74%
Canada 49887 75%
France 4062 68%
Italy 194 76%
Pakistan 1973 30%
Spain 35828 28 29%
Taiwan (Republic of China) 2042 77%
United Kingdom 53182 87%
United States 471689 49%
Table 1. Hypofractionation by country.

Conclusion: There is slow, but increasing uptake of hypofractionation for breast cancer, there remains little reporting in the literature by many countries around the world to assess true uptake. While

Author Disclosure: M. Culbert: None. J.F. De Los Santos: Independent Contractor; Up to Date. Research Grant; Varian. Medical Director; The UAB Kirklin Clinic at Acton Rd CCC. Board Member; Breast Cancer Research Foundation of AL. Co-PI; NCTN LAPs. PI for UAB; NRG. A.S. Wallace: Stock; Baxter, Baxalta, J&J, Shire, Edwards Life Science.

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