Hypofractionated radiotherapy
What changed?
- During the COVID-19 pandemic, a number of national and international cancer organisations and research associations, including the American Society for Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO), recommended that hypofractionated or short-course regimens be used where appropriate, to limit patient volumes in clinics and reduce risk to staff, and that increased use of hypofractionation be employed where possible for cancer patients with suspected or confirmed COVID-19.1,2,3,4,5
- The use of hypofractionated schedules increased in Australia and internationally for selected cancers, such as head and neck cancers, non-melanoma skin cancers and breast cancers.6,7
Impact of change
- There is evidence to suggest that, for select patients and cancers, hypofractionation of radiotherapy is not inferior to standard fractionation in terms of local and distant recurrence, cosmetic outcomes and overall survival;8 is not associated with increased toxicity;9 may result in improved quality of life for patients; and may be more appropriate compared to conventional radiotherapy.8,10
- Reducing the number of required clinic visits can minimise patient exposure to sources of infection and counteracts the increased pressure on the healthcare system during the pandemic.11,12
- There is unwarranted variation in the use of hypofractionation for several reasons and country-based differences, including availability of schedules, differences in training of health professionals, funding models and willingness to adopt new models.7,10 The nature and extent of such variations during the COVID-19 pandemic is unclear.10
How can high-value changes be embedded or enhanced?
The following strategies were identified in Australian and international literature and by leading Australian cancer experts and consumers. This list is provided to prompt considerations and future strategies to support high-value cancer care in the Recovery phases of the COVID-19 pandemic.
These strategies are listed at the system-, service-, practitioner-, and patient-levels and are intended to be used by a range of cancer control stakeholders across Australia to support high-value cancer care and improve outcomes for people with cancer.
System-level strategies
- Undertaking an economic evaluation to determine cost-effectiveness of the use of hypofractionation of radiotherapy compared to standard fractionation, in order to support the safe and appropriate use of hypofractionated radiotherapy and help minimise unwarranted variation in practice.10
- Reviewing approaches to support increased uptake of hypofractionation in the delivery of radiotherapy, where appropriate for the patient.7
Service-level strategies
- Developing and distributing tumour-specific, evidence-based and validated guidance and recommendations for the use of hypofractionated radiotherapy, including information on patient eligibility, standardised dose and fractionation schedules, and safety and toxicity concerns. Best-practice recommendations should be shared formally and via electronic means;13 this may require further research.10
Practitioner-level strategies
- Educating and training health professionals on the appropriate use of hypofractionated radiotherapy to minimise unwarranted variations in practice.7,14
Patient-level strategies
Last updated 12 January 2024
