Hypofractionation as a solution to radiotherapy access in latin america: expert perspective

Santos, Marcos; Chávez-Nogueda, Jessica; Galvis, Juan Carlos; Merino, Tomás; Silva, Luis Oliveria e; Ricco, Mariana; Sarria, Gustavo J; Sisamon, Ignacio; Garay, Ónix

doi:10.5603/rpor.a2022.0108

Cited by 6 publications

(3 citation statements)

References 61 publications

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“…Low rates of acute toxicity were observed in this study, No grade ≥ 3 acute toxicity were observed, are consistent with the findings of other studies that have evaluated hypofractionation schedules for prostate cancer (17,18,19,20), and the incidence rates of Grade ≥2 acute GU y GI toxicities pág. 7022…”

Section: Discussionsupporting

confidence: 92%

Acute Toxicity in Moderate Hypofractionation Over Three Weeks for Localized Prostate Cancer Without Marker Implantation

Galvis Serrano,

Pabon Girón,

Mosquera

et al. 2024

Ciencia Latina

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Purpose: prospective observational study of patients with localized prostate cancer referred for radiotherapy using a hypofractionation scheme without marker implantation with the advantages offered by shorter treatments in lower-middle-income countries. Our objective was to establish the acute genitourinary and gastrointestinal toxicity using hypofractionation radiotherapy scheme of 15 fractions. Methods and Materials: From March to November 2022, patients with low- to intermediate-risk prostate cancer received 54 Gy in 15 fractions (3.6 Gy per fraction) for 3 weeks using VMAT without intraprostatic fiducial markers or a rectal hydrogel spacer. Were evaluated through rectal examination, prostate-specific antigen (PSA) levels, and diagnostic imaging such as computed tomography (CT), magnetic resonance imaging (MRI), bone scan, or positron emission tomography (PET/CT) with PSM, the cumulative incidence of late grade ≥2 genitourinary and gastrointestinal toxicities were analyzed. Results: Thirty-six patients were enrolled in this prospective observational study; all of them were treated with highly hypofractionated VMAT with intermediate to high risk. The follow-up period was 3 months for evaluated acute toxicity. In terms of genitourinary toxicity, 8% of patients experienced grade 2 toxicity, which included urinary frequency, urgency, and dysuria. There were no cases of grade 3 or higher genitourinary toxicity. Regarding gastrointestinal toxicity, 5% of patients experienced grade 2 toxicity, which included diarrhea and rectal bleeding. No grade 3 or higher gastrointestinal toxicity was observed. Conclusions: Highly hypofractionated VMAT delivering 54 Gy in 15 fractions for 3 weeks for prostate cancer without intraprostatic fiducial markers facilitated favorable oncological outcomes without severe complications. These findings support the feasibility and safety of this treatment option and highlight the potential advantages of hypofractionation, further studies are needed to confirm these findings and evaluate the long-term oncological outcomes of moderate hypofractionation for localized prostate cancer.

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Section: Discussionsupporting

confidence: 92%

Acute Toxicity in Moderate Hypofractionation Over Three Weeks for Localized Prostate Cancer Without Marker Implantation

Galvis Serrano,

Pabon Girón,

Mosquera

et al. 2024

Ciencia Latina

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“…This study allows us to evaluate the safety profile of hypofractionated schemes in postoperative prostate cancer and the feasibility of including elective treatment of the pelvis, which is in line with what is recommended by area experts in the region [35]. However, this protocol has some limitations.…”

Section: Discussionmentioning

confidence: 72%

Moderate hypofractionated radiotherapy to the prostate bed with or without pelvic lymph nodes: a prospective trial

Canales,

Barnafi,

Salazar

et al. 2024

Rep Pract Oncol Radiother.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Starling,

Thibodeau,

de Sousa

et al. 2024

Cancers

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The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially in resource-limited settings. Hypofractionated radiotherapy (HRT) and ultra-hypofractionated/stereotactic body radiation therapy (SBRT) offer promising alternatives by shortening treatment durations. This approach optimizes the utilization of radiotherapy machines, making them more effective in meeting the growing demand for cancer care. Adopting HRT/SBRT holds significant potential, especially in LMICs. This review provides the latest clinical evidence and guideline recommendations for the application of HRT/SBRT in the treatment of breast, prostate, and lung cancers. It emphasizes the critical importance of rigorous training, technology, stringent quality assurance, and safety protocols to ensure precise and secure treatments. Additionally, it addresses practical considerations for implementing these treatments in LMICs, highlighting the need for comprehensive support and collaboration to enhance patient access to advanced cancer care.

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Hypofractionation as a solution to radiotherapy access in latin america: expert perspective

Abstract: This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited.

Cited by 6 publications

References 61 publications

Acute Toxicity in Moderate Hypofractionation Over Three Weeks for Localized Prostate Cancer Without Marker Implantation

Acute Toxicity in Moderate Hypofractionation Over Three Weeks for Localized Prostate Cancer Without Marker Implantation

Moderate hypofractionated radiotherapy to the prostate bed with or without pelvic lymph nodes: a prospective trial

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

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