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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},
}