ESTRO 2025 - Abstract Book

S2213

Interdisciplinary – Global health

ESTRO 2025

404

Digital Poster Can the FAST-Forward Ultrahypofractionated Breast Radiotherapy Expand Global Radiotherapy Access? Mohammad Akash 1 , Ahmed Salem 2,3 , Dana Abdelkader Al-Marahleh 1 , Fanar Al-Samarat 1 1 Faculty of Medicine, The Hashemite University, Zarqa, Jordan. 2 Department of Anatomy, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, Zarqa, Jordan. 3 Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom Purpose/Objective: Millions of breast cancer patients receive adjuvant radiotherapy. The FAST-Forward trial demonstrated non inferiority of ultrahypofractionated (26Gy/5Fx) compared to hypofractionated (40Gy/15Fx) radiotherapy. If the ongoing nodal sub-study yields positive results, it could further widen eligibility for ultrahypofractionated radiotherapy. Ultrahypofractionation could minimise radiotherapy resource utilisation and expand global access. We modelled the increase in access and financial savings that could be realised with the implementation of ultrahypofractionation for breast cancer. Material/Methods: Breast cancer incidence rates for 185 countries were extracted from GLOBOCAN 2022 and interpolated for 2022 2045 based on “CANCER TOMORROW”. The CCORE model was used to estimate breast radiotherapy utilisation. Eligibility for ultrahypofractionation was based on breast cancer stages included in the FAST-Forward trial and the nodal sub-study (if final results are positive). Staging data were extracted from the CCORE and Malaysian staging data and applied to high-income (HIC) and low-and middle-income countries (LMICs), respectively. Megavoltage machine (MvM) numbers were extracted from the Directory of Radiotherapy Centres. Considering one MvM has the capacity of delivering 9,700 fractions annually (Zubizarreta et al. 2015), this translates to treating 647 and 1,940 patients annually using hypofractionation and ultrahypofractionation, respectively, with 25% designated capacity for breast cancer. We calculated the cost per course using a time-driven activity-based costing analysis using previously published parameters (Van Dyk et al. 2017) incorporated into the Radiotherapy Cost Estimator (RTE) developed by the IAEA with equation provided.

Results: Ultrahypofractionation for both nodal and non-nodal patients increased the number of countries meeting radiotherapy demand from 82 (45.81%) to 115 (64.25%), with access gains ranging from 4.88% to full demand coverage in some countries.( Figure 1 and 3) The estimated costs per radiotherapy course for hypofractionation and ultrahypofractionation respectively were $414/ $1,107 in low-income countries (LIC), $572/$1,339 in lower-middle income countries (LO-MIC), $1,140/$2,181 in upper-middle-income-countries (UP-MIC), and $1,452/$2,713 in high income-countries (HIC). From 2022-2045, 65 million new breast cancer patients are projected to be diagnosed. Full implementation of ultrahypofractionation could result in projected maximum cost savings of $49 billion. In 2022 alone, adopting ultrahypofractionation over hypofractionation saved $1.35 billion globally, attributed to non-nodal patients. (Figure 2) Financial savings varied by income, highest in LICs (62%) and lowest in HICs (46.47%). Mean 52.52%, 95% CI ±0.906. (Table 1)