Adoption and Practice Variability of Prostate Stereotactic Body Radiotherapy (SBRT) in Latin America: The Role of...

Background Prostate cancer (PCa) is a highly prevalent disease in Latin America (LATAM), where access to radiotherapy is limited. Stereotactic body radiotherapy (SBRT) is an effective, safe, lower-cost, and more accessible option; however, its implementation requires protocol standardization and continuous education. This study aims to analyze the practices and procedures of a group of LATAM professionals who use the homogeneous Halcyon^TM technological platform to deliver prostate SBRT and to determine their concordance with the randomized trials PACE-B (Prostate Advances in Comparative Evidence - SBRT versus conventional or moderately hypofractionated radiotherapy), HYPO-RT-PC (Hypofractionated Radiotherapy for Prostate Cancer trial), and RTOG-0938 (Radiation Therapy Oncology Group trial 0938). Methodology A survey was conducted among 37 professionals (radiation oncologists and medical physicists) from 28 institutions in 10 Latin American countries. Concordance of their practices was analyzed across nine variables (five direct: prescription parameters; four indirect: safety and quality procedures) derived from the three reference trials. Results High adoption of hypofractionation (HRT) (86.5%) and SBRT (59.5%) was observed. Concordance with the trials was higher for indirect factors (65.0%) than for direct factors (41.3%), with only 36.2% mean concordance with the prescription parameters of the PACE-B trial. In addition, 40.5% of participants did not use SBRT, with lack of experience being the main barrier (66.7%). Conclusions Prostate SBRT is progressively consolidating in LATAM; however, meaningful variability persists in both dose prescription parameters and safety and quality procedures, despite access to homogeneous advanced technology. These findings indicate that while access to advanced technology is of critical importance, technology availability alone is not sufficient to ensure standardized, high-quality clinical practice. Strengthening continuous education, protocol harmonization, and robust quality assurance strategies represents a strategic opportunity to enhance consistency, safety, and clinical benefit across the region.