ESTRO 2024 - Abstract Book

S2731

Interdisciplinary - Global health

ESTRO 2024

1 IRCCS-CROB, Radiation Oncology Unit, Rionero in Vulture, Italy. 2 IRCCS-CROB, Physic Unit, Rionero in Vulture, Italy. 3 IRCCS-CROB, Physic Unit, Rionero in Vulture, Italy

Purpose/Objective:

Covid-19 (Co-19) pandemic has shown the safety and advantages of hypofractionated radiotherapy (Hypo-RT) and now it has become a new standard of care in many radiotherapy (RT) centres worldwide. In Basilicata, a country of South Italy where only two RT facilities are available, a population survey conducted in 2019 recorded a higher ageing population index over 65 years (+9%) and over 80 years (+39%) compared to the survey in 2011. Breast (BR), Prostate (PR) and Rectal (RE) cancers were found the most frequent tumors in the population ageing between 75- 85 years. Ageing, unfavourable metereology, geography and transport shortfalls of this country may influence the access to our RT facility. Thus Hypo-RT could be an alternative choise to overcome easier these challenges. We analyzed the changes and influencing factors on RT fractionation use in our daily practice from conventional (CF) to Hypo-RT before and after Co-19 pandemic.

Material/Methods:

We identified two periods : A period (from January 2018 to Jan 2019) and B period (from Jan 2022 to Jan 2023). From clinical records of our RT centre, data on doses fractionation and consumer factors (age, gender, comorbities, distance living, geographical areas, cares and transport avaibility) in BR, PR and RE cancer patients (pts) over 70 years old treated during these two periods were collected . The assessed fractionation schedules were CF : 2 Gy/fr /25-37 for BR, RE, PR cancers. Hypo- RT 20/5 (3 Gy/fr/20; 7,2 Gy/fr/5) in PR; Hypo-RT15/5 (2,67Gy/fr/15; 5.2 Gy/fr/5)in BR; Hypo-RT5 (5 Gy/fr/5) in RE cancers. The percent use of CF vs Hypo-RT 5/15/20 frs schedules were compared between the two periods (A vs B). Univariate and multivariate analyses were performed to identify factors influencing the Hypo-RT utilisation with t-test and Pearsons’s Covariance.

Results:

A total amount of 700 cases were collected. Mean age was 78 years (72-85 yrs). BR cancer were 40%, PR cancer 35%, RE cancer 25%. Overall a statistical significant decrease of CF use was recorded from A to B period (30.7% vs 11% p = 0.0035). The use of Hypo- RT increased from 22% in A to 35% in B (p= 0.0013). This difference remained significant for each tumor sites (BR 40% vs 85%; PR 40% vs 80%; RE 40 vs 65%). During B period, Hypo-RT 5 increased over Hypo-RT15 in BR (55% vs 30%) while in PR it was stable (30%) vs Hypo-RT20 (39%) with p=0,45. On univariate and multivariate analyses, the factors significantly associated with Hypo RT over utilisation in all tumor sites were: age > 75 yrs, female gender, living in most disadvantaged and regional areas (Bradanica vs Matera vs Marmo Platano vs Val Sinni vs Ionic areas), no care givers avaibility, transport shortfalls (car vs train vs bus) and increasing distance to the our RT facility ( > 100 Km). In BR cancer , age > 75 yrs and distance > 100 Km were the most significant findings for Hypo-RT5 regardless nodal RT (p= 0.004, 0.0011 respectively). Distance > 100 Km, female gender, no care giver avaibility, regional areas impacted on Hypo-RT 5 for RE cancer (p= 0.0032; 0.0023, 0.0037;0.0025, 0.0045 respectively). In PR cancer distance > 100 Km, transport shortfalls and comorbidities were significant for Hypo -RT 5 ( p= 0.0013, 0.0027, 0.0035 respectively).

Conclusion:

Before Co-19 pandemic moderate Hypo-RT (15/20 frs) schedules were an alternative choise over CF for BR and PR cancers while Hypo-RT5 use in RE cancer was mainly due to age-related comorbidities. Hypo-RT5 use in BR cancer has been increased since the Fast trial publishing paper. After the Co-19 pandemic emergency, in our clinical practice CF has been completely abandoned in favor of Hypo-RT in the very old population. Hypo-RT 5/15/20