Implementation and utilization of hypofractionation for breast cancer

Area of Science:

• Radiation Oncology
• Breast Cancer Treatment
• Clinical Practice Guidelines

Background:

• Hypofractionation (HF) for whole breast irradiation is a standard treatment with equivalent survival and local control to conventional fractionation.
• Despite evidence and American Society for Radiation Oncology (ASTRO) guidelines, HF utilization remains lower than predicted.
• Barriers to HF adoption in large, multicenter settings require investigation.

Purpose of the Study:

• To evaluate the impact of clinical directives and prospective contouring rounds on the implementation of HF for breast cancer treatment.
• To assess changes in HF utilization rates in a large, multicenter radiation oncology department.

Main Methods:

• Implementation of consensus-driven, evidence-based clinical directives for treatment decisions in 2010.
• Institution of prospective contouring rounds for peer-review of directive selection and patient contours starting in 2012.
• Analysis of 1043 early-stage breast cancer cases treated under ASTRO 2011 guidelines and institutional directives.

Main Results:

• For the ASTRO-endorsed group (n=685), HF utilization increased from 49% in 2011 to 80% in 2015.
• For the directives-endorsed group (n=1042), HF utilization increased from 47% in 2011 to 73% in 2015.
• These findings demonstrate a significant increase in HF adoption following the interventions.

Conclusions:

• Hypofractionation (HF) is underutilized despite its benefits, including equivalent local control and a superior toxicity profile.
• Combining consensus-based treatment directives with prospective contouring rounds can significantly improve HF utilization in large, multisite settings.
• This study presents a novel approach to changing practice patterns and increasing the adoption of evidence-based treatments like HF.