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Utilization of Hypofractionated Radiation Therapy in Breast Cancer

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Key Points

  • Researchers implemented consensus-based, evidence-driven guidelines to help medical professionals make treatment decisions for patients.
  • A prospective peer-reviewed case review program was also established in the radiation department where the course of treatment for each patient was reviewed for a consensus opinion.
  • When there was a disagreement, the treating physician was expected to defend his or her choice and influence the group to change their mind or go with the consensus opinion.

Researchers at the Feinstein Institute for Medical Research and Northwell Health’s Department of Radiation Medicine have identified methods to increase use of the radiation therapy hypofractionation in patients with breast cancer. These findings, published by Gilbo et al in Advances in Radiation Oncology, demonstrate that most patients with breast cancer can be treated with with this type of radiation therapy that is as effective as current treatments but has lower toxicity levels.

Hypofractionated radiation therapy is a type of radiation therapy where a higher dose of radiation is administered over a shorter timeframe. Up until recently, it was thought that hypofractionated radiation therapy was ineffective in breast cancer. However, randomized clinical trials proved that this therapy is comparable to other radiation therapies in effectiveness while being less toxic. Even with these data, the adoption of this therapy in the United States is significantly lower than countries and regions with similar levels of medical care like Canada and Europe. Researchers in this study, including Lucille Nichols Lee, MD, Feinstein Institute member and Assistant Professor of Radiation Medicine at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, looked to see if implementing certain programs in the radiation medicine department at would help to increase adoption.

“Hypofractionated radiation therapy is underused in the treatment of breast cancer despite equal control, less acute toxicity, and similar side effects,” said Dr. Lee. “We found that through the development of consensus-based treatment directives and peer review of cases by faculty in Northwell’s radiation medicine department that our adoption rate of this therapy increased to more than 73% of woman treated for breast cancer.”

Implementation

In this study, researchers implemented consensus-based evidence-driven guidelines to help medical professionals make treatment decisions for patients. A prospective peer-reviewed case review program was also established in the radiation department where the course of treatment for each patient was reviewed for a consensus opinion. When there was a disagreement, the treating physician was expected to defend his or her choice and influence the group to change their mind or go with the consensus opinion. This all helped to increase adoption of hypofractionated radiation therapy for patients whose cancer met the criterion for this course of therapy.

“Being treated in 3 weeks instead of 6, as seen with hypofractionation, is something that many breast cancer patients are looking for as it means less disruption of their daily lives,” said Chairman of the Department of Radiation Medicine at Northwell Health and Feinstein Institute Professor Louis Potters, MD, who is also an author of the study. “By developing this program to increase adoption, we are both meeting the patient’s needs of reduced treatment time and less toxicity, while also educating the medical community that the treatment regimen is an effective alternative.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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