Hypofractionated Prostate Radiation Therapy: Adoption and Dosimetric Adherence Through Clinical Pathways in an Integrated Oncology Network

PURPOSE: Updates to consensus guidelines in October 2018 recommending moderately hypofractionated external beam radiotherapy (mHF-EBRT) prostate cancer lagged several years after publication of evidence supporting its efficacy. In January 2018, we amended our clinical pathway (CP) facilitate adoption mHF-EBRT. Herein, analyze patterns care and changes mHF-EBRT use the CP modification. METHODS: Our was make recommended treatment for patients with low- intermediate-risk pursuing curative EBRT monotherapy. Normal-tissue dose constraints accompanied modification guide planning. Use from 2015 2017 compared modification, using Cochran-Armitage test trend. Predictors adherence were analyzed binary logistic regression. RESULTS: 560 treated monotherapy, increased 3.7% 2015-2017 85.6% ( P < .001), whereas conventionally fractionated (CF-EBRT) decreased 96.3% 14.4% .001). Consultation year (odds ratio [OR], 214.6; 95% CI, 94.5 484.6; at an academic facility (OR, 4.5; 1.8 11.3; = 0.001), having a smaller 0.99; 0.97 1.00; .028) predicted use. At least five six bladder rectal met 89.4% patients. CONCLUSION: Modification CP, concert institutional policies monitor audit compliance, facilitated rapid large, integrated center good dosimetric constraints.