Benefits of Adopting Hypofractionated Radiotherapy as a Standard of Care in Low-and Middle-Income Countries

Abstract

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Risk-Tailoring Radiotherapy for Endometrial Cancer: A Narrative Review

“…Similar studies have been completed in cancers of other disease sites, which have demonstrated similar toxicity profiles and comparable oncologic outcomes between shorter and longer radiation courses [86][87][88][89][90]. Additionally, these shorter courses of treatment have been associated with decreased costs to the healthcare system and improved access and convenience for patients [91]. One study evaluating the safety and efficacy of a hypofractionated pelvic radiotherapy approach in patients with endometrial cancer is RT-PACE [92,93].…”

Stereotactic Body Radiotherapy (SBRT) to Localised Prostate Cancer in the Era of MRI-Guided Adaptive Radiotherapy: Doses Delivered in the HERMES Trial Comparing Two- and Five-Fraction Treatments

“…There is ongoing debate regarding the cost of MRIgART and the length of time spent on the treatment couch [ 33 ]. This work adds to the expanding evidence supporting the move to increasingly hypofractionated regimes due to the socio-economic benefits to hospitals and patients, with a reduction in travel costs, re-location costs, time off work and improved toxicity outcomes for patients [ 34 ]. Furthermore, treatment on the MRL negates the need for fiducial markers and radiation exposure secondary to cone beam CT or X-rays, meaning that, although treatment requiring fiducials and/or CT guidance may provide a safe approach to implementing CTV-PTV margin reduction, it remains invasive and with the associated risks [ 35 ].…”

Optimizing Clinical Implementation of Hypofractionation: Comprehensive Evidence Synthesis and Practical Guidelines for Low- and Middle-Income Settings

“…Although not mandatory, certain prerequisites are recommended for safely implementing HRT. These include a linear accelerator (LINAC) for three-dimensional conformal radiation therapy (3DCRT), CT treatment simulation with sub-3 mm slice reconstruction, both forward and inverse treatment planning software, proper immobilization devices, a comprehensive QA protocol, and a team of well-trained radiation oncology professionals [16,[20][21][22].…”

“…While these are the minimum standards for safely and adequately delivering HRT, the preferred treatment delivery method involves volumetric modulated arc therapy (VMAT) or intensity-modulated RT (IMRT) utilizing a minimum 6 MV beam, accompanied by onboard image guidance and motion tracking systems [16]. In addition, regardless of the chosen technique (3DCRT, IMRT, or VMAT), certain QA tasks should be performed more frequently than the standard LINAC QA guidelines of the Task Group 142 report [23].…”

“…Hypofractionated RT (HRT) has emerged as a viable solution for tackling the scarcity of RT, particularly in LMICS. HRT involves administering a higher radiation dose with each session (fraction) using either moderate (>2-4 Gy per fraction) or ultra-hypofractionation (>5 Gy per fraction) [14], thereby reducing the overall duration of RT [10,15,16]. From a radiobiological standpoint, hypofractionation offers many therapeutic benefits, especially for tumors characterized by low α/β ratios [17].…”