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Thoughts on Hypofractionation for Prostate Cancer: International Survey Says...

By: Jenna Carter, PhD
Posted: Friday, September 29, 2023

Delivering larger doses of radiation over shorter periods, better known as hypofractionation, has been shown to improve access to care and decrease the cost of treatment. However, the factors influencing hypofractionation uptake and its use in low-resource settings are not clearly understood. Osama Mohamad, MD, PhD, of the University of California San Francisco, and colleagues used data from the European Society of Radiation Oncology’s Global Impact of Radiotherapy in Oncology initiative survey on hypofractionation and found that in the curative setting, hypofractionation was most often preferred for low- and intermediate-risk prostate cancers. They also found that most respondents preferred hypofractionation in the palliative setting. The results of this international survey were published in JCO Global Oncology.

This survey was anonymously administered to radiation oncologists from 2018 to 2019. Collected data from a total of 1,157 physicians were the focus of this study. Data included hypofractionation regimen use for several prostate cancer scenarios, physician demographics, and clinical practice characteristics. Physicians also responded to questions about specific justifications and barriers to adopting hypofractionation. Answers were then stratified by World Bank income group, and multivariate logistic regression models were used to analyze variables associated with hypofractionation preference.

Overall findings revealed that 60% of respondents were from high-income countries. In the clinical setting, hypofractionation was most often preferred for low- and intermediate-risk prostate cancers. Additionally, 89% of physicians preferred hypofractionation in the palliative setting. Furthermore, respondents from upper middle–income countries and lower middle–income and low-income countries were significantly less likely to prefer hypofractionation than were those from high-income countries (P < .001). Finally, adoption of hypofractionation was mainly favored by the availability of published evidence, the authors noted, and fear of worse late toxicity was listed as a concern.

Disclosure: For full disclosures of the study authors, visit

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