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@ARTICLE{Mushonga:212547,
author = {M. Mushonga and J. Weiss and Z. A. Liu and A.-M. Nyakabau
and O. Mohamad and B. Tawk$^*$ and F. Y. Moraes and S.
Grover and M. L. Yap and E. Zubizarreta and Y. Lievens and
D. Rodin},
title = {{H}ypofractionation in {B}reast {C}ancer {R}adiotherapy
{A}cross {W}orld {B}ank {I}ncome {G}roups: {R}esults of an
{I}nternational {S}urvey.},
journal = {JCO global oncology},
volume = {9},
number = {9},
issn = {2378-9506},
address = {Alexandria, VA},
publisher = {American Society of Clinical Oncology},
reportid = {DKFZ-2023-00232},
pages = {e2200127},
year = {2023},
abstract = {Hypofractionated breast radiotherapy has been found to be
equivalent to conventional fractionation in many clinical
trials. Using data from the European Society for
Radiotherapy and Oncology Global Impact of Radiotherapy in
Oncology survey, we identified preferences for
hypofractionation in breast cancer across World Bank income
groups and the perceived facilitators and barriers to its
use.An international, electronic survey was administered to
radiation oncologists from 2018 to 2019. Demographics,
practice characteristics, preferred hypofractionation
regimen for specific breast cancer scenarios, and
facilitators and barriers to hypofractionation were reported
and stratified by World Bank income groups. Variables
associated with hypofractionation were assessed using
multivariate logistic regression models.One thousand four
hundred thirty-four physicians responded: 890 $(62\%)$ from
high-income countries (HICs), 361 $(25\%)$ from
upper-middle-income countries (UMICs), 183 $(13\%)$ from
low- and lower-middle-income countries (LLMICs).
Hypofractionation was preferred most frequently in
node-negative disease after breast-conserving surgery, with
the strongest preference reported in HICs $(78\%$ from HICs,
$54\%$ from UMICs, and $51\%$ from LLMICs, P < .001).
Hypofractionation for node-positive disease postmastectomy
was more frequently preferred in LLMICs $(28\%$ from HICs,
$15\%$ from UMICs, and $35\%$ from LLMICs, P < .001).
Curative doses of 2.1 to < 2.5 Gy in 15-16 fractions were
most frequently reported, with limited preference for
ultra-hypofractionation, but significant variability in
palliative dosing. In adjusted analyses, UMICs were
significantly less likely than LLMICs to prefer
hypofractionation across all curative clinical scenarios,
whereas respondents with > 1 million population catchments
and with intensity-modulated radiotherapy were more likely
to prefer hypofractionation. The most frequently cited
facilitators and barriers were published evidence and fear
of late toxicity, respectively.Preference for
hypofractionation varied for curative indications, with
greater acceptance in earlier-stage disease in HICs and in
later-stage disease in LLMICs. Targeted educational
interventions and greater inclusivity in radiation oncology
clinical trials may support greater uptake.},
cin = {HD01},
ddc = {610},
cid = {I:(DE-He78)HD01-20160331},
pnm = {899 - ohne Topic (POF4-899)},
pid = {G:(DE-HGF)POF4-899},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:36706350},
doi = {10.1200/GO.22.00127},
url = {https://inrepo02.dkfz.de/record/212547},
}