. 2021 Nov 1;4(11):e2129647.

doi: 10.1001/jamanetworkopen.2021.29647.

Evaluation of Hypofractionated Radiation Therapy Use and Patient-Reported Outcomes in Men With Nonmetastatic Prostate Cancer in Australia and New Zealand

David I Pryor^{1

2}, Jarad M Martin^{3

4}, Jeremy L Millar^{5

6}, Heather Day², Wee Loon Ong^{5

6}, Marketa Skala⁷, Liesel M FitzGerald⁸, Benjamin Hindson⁹, Braden Higgs^{10

11}, Michael E O'Callaghan^{12

13}, Farhan Syed^{14

15}, Amy J Hayden^{16

17}, Sandra L Turner^{16

18}, Nathan Papa⁵

Affiliations

¹ Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
² Australian Prostate Cancer Research Centre-QLD, Queensland University of Technology, Brisbane, Queensland, Australia.
³ Department of Radiation Oncology Calvary Mater Hospital Newcastle, Newcastle, New South Wales, Australia.
⁴ University of Newcastle School of Medicine and Public Health, Newcastle, New South Wales, Australia.
⁵ Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
⁶ Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.
⁷ Department of Radiation Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
⁸ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
⁹ Canterbury Regional Cancer and Haematology Service, Christchurch, New Zealand.
¹⁰ Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
¹¹ University of South Australia, Adelaide, South Australia, Australia.
¹² Urology Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.
¹³ Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.
¹⁴ Department of Radiation Oncology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
¹⁵ ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia.
¹⁶ Sydney West Radiation Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
¹⁷ Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
¹⁸ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

PMID: 34724555
PMCID: PMC8561328
DOI: 10.1001/jamanetworkopen.2021.29647

Evaluation of Hypofractionated Radiation Therapy Use and Patient-Reported Outcomes in Men With Nonmetastatic Prostate Cancer in Australia and New Zealand

David I Pryor et al. JAMA Netw Open. 2021.

. 2021 Nov 1;4(11):e2129647.

doi: 10.1001/jamanetworkopen.2021.29647.

Authors

Affiliations

¹ Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
² Australian Prostate Cancer Research Centre-QLD, Queensland University of Technology, Brisbane, Queensland, Australia.
³ Department of Radiation Oncology Calvary Mater Hospital Newcastle, Newcastle, New South Wales, Australia.
⁴ University of Newcastle School of Medicine and Public Health, Newcastle, New South Wales, Australia.
⁵ Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
⁶ Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.
⁷ Department of Radiation Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
⁸ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
⁹ Canterbury Regional Cancer and Haematology Service, Christchurch, New Zealand.
¹⁰ Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
¹¹ University of South Australia, Adelaide, South Australia, Australia.
¹² Urology Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.
¹³ Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.
¹⁴ Department of Radiation Oncology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
¹⁵ ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia.
¹⁶ Sydney West Radiation Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
¹⁷ Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
¹⁸ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

PMID: 34724555
PMCID: PMC8561328
DOI: 10.1001/jamanetworkopen.2021.29647

Abstract

Importance: Randomized clinical trials in prostate cancer have reported noninferior outcomes for hypofractionated radiation therapy (HRT) compared with conventional RT (CRT); however, uptake of HRT across jurisdictions is variable.

Objective: To evaluate the use of HRT vs CRT in men with nonmetastatic prostate cancer and compare patient-reported outcomes (PROs) at a population level.

Design, setting, and participants: Registry-based cohort study from the Australian and New Zealand Prostate Cancer Outcomes Registry (PCOR-ANZ). Participants were men with nonmetastatic prostate cancer treated with primary RT (excluding brachytherapy) from January 2016 to December 2019. Data were analyzed in March 2021.

Exposures: HRT defined as 2.5 to 3.3 Gy and CRT defined as 1.7 to 2.3 Gy per fraction.

Main outcomes and measures: Temporal trends and institutional, clinicopathological, and sociodemographic factors associated with use of HRT were analyzed. PROs were assessed 12 months following RT using the Expanded Prostate Cancer Index Composite (EPIC)-26 Short Form questionnaire. Differences in PROs were analyzed by adjusting for age and National Comprehensive Cancer Network risk category.

Results: Of 8305 men identified as receiving primary RT, 6368 met the inclusion criteria for CRT (n = 4482) and HRT (n = 1886). The median age was 73.1 years (IQR, 68.2-77.3 years), 2.6% (168) had low risk, 45.7% (2911) had intermediate risk, 44.5% (2836) had high-/very high-risk, and 7.1% (453) had regional nodal disease. Use of HRT increased from 2.1% (9 of 435) in the first half of 2016 to 52.7% (539 of 1023) in the second half of 2019, with lower uptake in the high-/very high-risk (1.9% [4 of 215] to 42.4% [181 of 427]) compared with the intermediate-risk group (2.2% [4 of 185] to 67.6% [325 of 481]) (odds ratio, 0.26; 95% CI, 0.15-0.45). Substantial variability in the use of HRT for intermediate-risk disease remained at the institutional level (median 53.3%; range, 0%-100%) and clinician level (median 57.9%; range, 0%-100%) in the last 2 years of the study period. There were no clinically significant differences across EPIC-26 urinary and bowel functional domains or bother scores.

Conclusions and relevance: In this cohort study, use of HRT for prostate cancer increased substantially from 2016. This population-level data demonstrated clinically equivalent PROs and supports the continued implementation of HRT into routine practice. The wide variation in practice observed at the jurisdictional, institutional, and clinician level provides stakeholders with information that may be useful in targeting implementation strategies and benchmarking services.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Pryor reported receiving grants from the Movember Foundation during the conduct of the study and personal fees from Janssen-Cilag Speaker outside the submitted work. Dr Martin reported receiving grants from Mundipharm, grants from Varian, and personal fees from AbbVie outside the submitted work. Mrs Day reported receiving grants from the Movember Foundation during the conduct of the study. No other disclosures were reported.

Figures

**Figure 1.. Patient Flow Diagram**
CRT indicates conventional radiation therapy; EPIC-26, Expanded Prostate Cancer Index Composite–26; HRT, hypofractionated radiation therapy; PCOR-ANZ, Australian and New Zealand Prostate Cancer Outcomes Registry; and RT, radiation therapy.

**Figure 2.. Variation in the Use of Moderately Hypofractionated Radiation Therapy (HRT) Over Time for Intermediate-Risk Prostate Cancer**
CRT indicates conventional radiation therapy; NSW/ACT, New South Wales and Australian Capital Territory; and SA/NT, South Australia and Northern Territory.

See this image and copyright information in PMC

References

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Evaluation of Hypofractionated Radiation Therapy Use and Patient-Reported Outcomes in Men With Nonmetastatic Prostate Cancer in Australia and New Zealand

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Evaluation of Hypofractionated Radiation Therapy Use and Patient-Reported Outcomes in Men With Nonmetastatic Prostate Cancer in Australia and New Zealand

Authors

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Abstract

Conflict of interest statement

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