ESTRO 2024 - Abstract Book

S2870

Interdisciplinary - Health economics & health services research

ESTRO 2024

Radio oncologists from various states from Brazil completed the questionnaire. In 2018, of a total of 135 radio oncologists, 40% indicated hypofractionation, while in 2021, in the pandemic situation, this percentage increased to 69.3% of 173 participants. In the first phase, in 2018, the most common limitation to indicate HFRT was unavailable technology (76.5%), such as Image-Guided Radiation Therapy (IGRT) or Intensity-Modulated Radiation Therapy (IMRT). Second, a quarter justified inadequate payment from the sources. In the HFRT group, 70.4% had two years or less experience. The most prevalent moderate regimen was 60Gy in 20 fractions (77.8%) using IMRT or VMAT technique (90.7%). On the other hand, in the conventional fractionation group, the fractionation regimen was variable (range: 70 – 78Gy), maintaining 2Gy/day. The planning 3D technique was the most common (65.4%). Although 34.5% used IMRT/VMAT to plan, 65.4% did not have IGRT available. In the second phase in 2021, during the COVID-19 pandemic reality, some questions were added in the first questionnaires based on new reality to evaluate recent patterns. In total, 173 radiation oncologists participated in the study, and 120 indicated HFRT. The main motive for the unique patterns in the last year was tied between technological implementation and the maturity of clinical results. At the same time, the COVID was used as justified to hypofractionate in only 3 participants. The most prevalent dose regimen prescribed was 60Gy in 20 fractions in the moderate HFRT and 36.25Gy in 5 fractions for SBRT. In the HFRT group, most planned with IMRT/ VMAT (92.5%) technology. Even though a quarter of the hypofractionation group did not have CBCT available, 71.6% had daily IGRT, and 20% used the protocol of images in the three first days and weekly images to guide. Although moderate HFRT became standard for most departments, 73.4% did not indicate SBRT. Despite the pandemic, the major limitation to indicate HFRT (71.6%) was the absence of technology (IMRT/VMAT or IGRT). Viewing that in the conventional fractionation group, the technology was limited; 79.2% used 3D-conventional planning, and 90.5% did not do any IGRT. The radio oncologist considered a secondary obstacle was the form of payment of the sources, even private health insurance or public health. A cross-analysis was made based on participants in both moments. Of 47 radio oncologists who answered the questionnaires in 2018 and 2020, 21 departments started hypofractionation and 17 ultra-hypofractionation. The time of experience: less than one year, one year, or two years or more were 23.8%, 19%, and 47.6%, respectively. The first time, the regimen in less fractionation was not applied due to needing more experience in clinical trials. Among these departments, only 9.5% belong to public service, 42.8% to private or health insurance, and 42.8% to mixed service.

Conclusion:

Moderate or ultra-hypofractionated regimens can optimize prostate cancer radiotherapy treatments. Thus, it could increase the accessibility of treatment patients with lower costs to public health. The indication of HFRT to treat PCa grew in Brazil, though there is still a role for SBRT. The emphasis on improving continued education and technology is the most critical issue, even considering the pandemic COVID- 19.

Keywords: hypofractionation - prostate cancer - LMIC

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