ESTRO 2024 - Abstract Book

S2714

Interdisciplinary - Education in radiation therapy

ESTRO 2024

(2). We seek to understand the current hypofractionation practice patterns in LAC and hypothesize that education is perceived as a barrier for using hypofractionated radiation schedules in Latin America that could be overcomed by educational strategies.

Material/Methods:

The non-profit Rayos Contra Cancer (RCC) developed a free of charge e-learning hypofractionation program for LAC countries. The program consisted of 13 virtual sessions taught by international educators focused on breast, prostate, rectal cancer, and high-grade glioma. The course was offered in two modalities: one with synchronous participation during live sessions, and another with asynchronous participation (not connecting during live sessions). Both formats allowed full access to educational materials and recordings. Live translation services were available from English to Spanish and Portuguese for English-speaking educators. Participants selected their method of participation and provided demographic information. Those that selected synchronous participation also completed pre- and post-curriculum questionnaires regarding hypofractionation attitudes, 1 to 5 Likert-scale self-confidence and physicians were asked additional detailed questions for practices for 12 prespecified clinical scenarios. We further analyzed the pre- and post-curriculum answers of practicing radiation oncologists that attended the live lectures to determine if their participation in the hypofractionation curriculum changed their attitudes or use of hypofraction. Physicians’ responses were categorically scored “1” (for hypofractionation or ultrahypofractionation) or “0” (for conventional fractionation). We used the McNemar test to detect differences in education as a barrier and hypofractionation selection. 1453 persons accross 21 LAC countries enrolled in the course; overall enroll participants were: radiation oncologists (n=631, 43.4%, 401 synchronous and 230 asynchronous), radiation oncology residents (n=100, 6.9%), medical physicists (n=421, 29.0%), medical physics residents (n=82, 5.6%, therapists (n=94, 6.5%), dosimetrist (n=110), nurses (n=4, 0.3%) and others (n=11, 0.8%). The total was 929 synchronous participants and 524 asynchronous participants. The 401 radiation oncologists who chose the synchronous modality, represented 18 LAC countries (Figure 1), 89.8% (n=360) of the radiation oncologist had IMRT and CBCT availability in their clinics. At baseline, ultrahypofractionation was mostly preferred for elderly women with ESBC (n=175, 43.6%). Moderate hypofractionation was preferred for younger women with ESBC (n=303, 75.6%), older women with stage IIB (n=329, 82.0%) and in the postmastectomy setting with regional node irradiation (n=270, 67.3%). In prostate cancer, hypofractionation was the preferred regimen for Favorable Intermediate Risk (FIR), Unfavorable Intermediate Risk (UIR) and High disease (n=321, 80.1%; n=291,72.6%; and n=231, 57.6%, respectively). For rectal cancer, preoperative conventional fractionation was the preferred regimen across all disease scenarios, ultra hypofraction was the most considered for patients with medium rectal T3N1 disease (n=183, 45.6%) in contrary to N2 disease (n=119, 29.7%). Ultra hypofraction was less considered for distal rectal cancer (n=105, 26.2%). For high-grade gliomas, hypofractionation was the preferred regimen in patients with a poor performance status (European Collaborative Oncology Group [ECOG] Performance Status of 2): 70.1%(n=281) and 49.1%(n=197) in older and in younger patients respectively. The selection of hypofractionation decreased to 25.2% (n=101) for an older patient with an ECOG performance status of 0 to 1. Among 401 participating radiation oncologists in the synchronous program, 240 (59.8%) from 16 LAC countries answered both pre- and post-curriculum surveys. When compared to their baseline answers, there was a significant increase in the use of hypofractionation for all 12 clinical scenarios, the highest percentage increase was seen for the use of ultra hypofractionation in a case of stage IIB breast cancer (33% to 85%, p<0.001). Furthermore, amongst these physicians, the perception of education as a barrier for the use of ultra hypofractionation (for breast, prostate and rectal cancer) and moderate hypofractionation (for prostate and CNS glioma) significantly decreased after the curriculum (Figure 2). Results: