Amending the prostate cancer clinical pathway to include moderately hypofractionated external beam radiotherapy (mHF-EBRT) as the recommended treatment for low- and intermediate-risk prostate cancer led to rapid adoption, with good adherence to dosimetric constraints, at a large, integrated cancer center (JCO Oncology Practice. 2020. doi:10.1200/OP.20.00508 JCO).
“Updates to consensus guidelines in October 2018 recommending mHF-EBRT in prostate cancer lagged several years after publication of evidence supporting its efficacy,” wrote authors from the University of Pittsburgh School of Medicine. “In January 2018, we amended our prostate cancer clinical pathway to facilitate adoption of mHF-EBRT.”
The clinical pathway established mHF-EBRT as the recommended treatment for patients with low- and intermediate-risk prostate cancer pursuing curative EBRT monotherapy. To guide planning, the clinical pathway modification provided normal-tissue dose constraints.
Among a total 560 patients who received EBRT monotherapy, use of mHF-EBRT grew from just 3.7% in 2015-2016 to 85.6% in 2018, researchers reported. Use of conventionally fractionated EBRT dropped from 96.3% to 14.4%.
Factors predicting mHF-EBRT use included consultation in 2018, treatment at an academic facility, and having a smaller prostate, according to the study.
“At least five of six recommended bladder and rectal dose constraints were met in 89.4% of patients,” researchers reported.—Jolynn Tumolo
