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. 2025 Jun 12;20(1):99.
doi: 10.1186/s13014-025-02669-w.

Implementation of ultra-hypofractionated radiotherapy for breast cancer in the Netherlands in 2020-2023, using registry data and questionnaires

Anouk H Eijkelboom  1 , Eva J A van Beek  2 , Marcel R Stam  3 , Paulien Westhoff  4 , Marissa C van Maaren  1   2 , Margriet G A Sattler  5 , Enja J Bantema-Joppe  6 , Marcel Verheij  1   7 , Desirée H J G van den Bongard  8 , Sabine Siesling  9   10 ; NABON-COVID-19 Consortium and the COVID and Cancer-NL Consortium
Collaborators, Affiliations

Implementation of ultra-hypofractionated radiotherapy for breast cancer in the Netherlands in 2020-2023, using registry data and questionnaires

Anouk H Eijkelboom et al. Radiat Oncol. .

Abstract

Background: This study investigated the implementation of ultra-hypofractionated radiotherapy (i.e. 5 fractions) in DCIS and early-stage breast cancer, factors associated with its use, and variation across radiotherapy institutes.

Methods: Registry and questionnaire data were used. Registry data included data from the Netherlands Cancer Registry and the NABON Breast Cancer Audit-Radiotherapy (NBCA-R). Women eligible for 5 fractions were included. Trends and variation were visualised using trendlines and case-mix adjusted boxplots. Logistic regression was applied to investigate which factors were associated with the use of 5 fractions. In April 2024 a questionnaire was distributed among radiotherapy institutes to identify facilitators and barriers for implementation.

Results: The current study included 16,115 women. In 2020, 18.5% of the eligible women received 5 fractions, compared to 60.8% in 2023. The lowest variation between radiotherapy institutes was found in 2023 (median: 60.4%, interquartile range: 53.3-70.6%). Age, tumour grade, multifocality, (y)pT, (y)pN, radiotherapy target volume, type of radiotherapy institute, and start year of radiation were associated with the chance of receiving 5 fractions. Sixteen out of the 19 radiotherapy institutes completed the questionnaire, showing variation in age and radiotherapy target volume for which the schedule was used. Most institutes mentioned no barriers for using 5 fractions. Questionnaire data confirmed the trendline finding that national consensus meetings were essential for largescale implementation.

Conclusions: The use of ultra-hypofractionated radiotherapy has increased during the past four years, with reduced variation across Dutch institutes. Registry and questionnaire data indicated that national consensus meetings were instrumental in driving implementation.

Keywords: Breast cancer; Questionnaires; Radiotherapy; Registries.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Privacy Review Board of the NCR confirmed that no ethical approval was required for the current study, because of the retrospective design and the anonymized patient data. Competing Interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Radiotherapy schedules of patients treated with radiotherapy in the Netherlands from 2020 until 2023. LPRM: National Platform Radiotherapy Breast Cancer. *: March 2020 – Start COVID-19 pandemic and publication of COVID-related measures, April and July 2020 – Publication FAST trials, November 2020 and April 2021: LPRM meetings
Fig. 2
Fig. 2
Case-mix adjusted variation between radiotherapy institutes in the percentage of patients treated with 5 fractions Logistic regression
Fig. 3
Fig. 3
Number of radiotherapy institutes who provided 5 × 5.2 Gy in April 2024, per radiotherapy target volume. PBI: partial breast irradiation, PMRT: post-mastectomy radiotherapy, WBI: whole breast irradiation
Fig. 4
Fig. 4
Ages at which 5 × 5.2 Gy was provided in April 2024, per radiotherapy target volume. PBI: partial breast irradiation, PMRT: post-mastectomy radiotherapy, WBI: whole breast irradiation
Fig. 5
Fig. 5
Reasons to refrain from using 5 × 5.2 Gy in April 2024, by radiotherapy target volume. PBI: partial breast irradiation, PMRT: post-mastectomy radiotherapy, WBI: whole breast irradiation
Fig. 6
Fig. 6
First implementation of 5 × 5.2 Gy and/or 5 × 5.7 Gy over time. PBI: partial breast irradiation, PMRT: post-mastectomy radiotherapy, RT: radiotherapy, WBI: whole breast irradiation. *LPRM guideline was updated in June 2021
See this image and copyright information in PMC

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