Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Stereotactic radiotherapy of the prostate: fractionation and utilization in the United States

  • Weiner, Joseph P. (Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System) ;
  • Schwartz, David (Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System) ;
  • Shao, Meng (Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System) ;
  • Osborn, Virginia (Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System) ;
  • Choi, Kwang (Department of Radiation Oncology, SUNY Downstate Medical Center) ;
  • Schreiber, David (Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System)
  • Received : 2016.11.14
  • Accepted : 2017.02.06
  • Published : 2017.06.30
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Abstract

Purpose: To analyze the utilization and fractionation of extreme hypofractionation via stereotactic body radiotherapy (SBRT) in the treatment of prostate cancer. Materials and Methods: Data was analyzed on men diagnosed with localized prostate cancer between 2004-2012 and treated with definitive-intent radiation therapy, as captured in the National Cancer Database. This database is a hospital-based registry that collects an estimated 70% of all diagnosed malignancies in the United States. Results: There were 299,186 patients identified, of which 4,962 (1.7%) were identified as receiving SBRT as primary treatment. Of those men, 2,082 had low risk disease (42.0%), 2,201 had intermediate risk disease (44.4%), and 679 had high risk disease (13.7%). The relative utilization of SBRT increased from 0.1% in 2004 to 4.0% in 2012. Initially SBRT was more commonly used in academic programs, though as time progressed there was a shift to favor an increased absolute number of men treated in the community setting. Delivery of five separate treatments was the most commonly utilized fractionation pattern, with 4,635 patients (91.3%) receiving this number of treatments. The most common dosing pattern was $725cGy{\times}5fractions$ (49.6%) followed by $700cGy{\times}5fractions$ (21.3%). Conclusions: Extreme hypofractionation via SBRT is slowly increasing acceptance. Currently $700-725cGy{\times}5fractions$ appears to be the most commonly employed scheme. As further long-term data regarding the safety and efficacy emerges, the relative utilization of this modality is expected to continue to increase.

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References

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