Apr 14th 2022

Hypofractionation Radiation Therapy Is Valuable for Treating Breast and Prostate Cancer

In the ever-changing world of cancer care, any type of treatment that offers benefits and advantages over traditional methods is worthy of consideration.

While some newer approaches in the complex field of radiation oncology are still lacking sufficient evidence around efficacy, there is a type of radiation therapy— hypofractionation—that has proven to be highly effective and valuable for two of the most common cancers among women and men: breast cancer and prostate cancer.

Hypofractionation is a radiation therapy that increases the amount of radiation given each day while reducing the total length of treatment time by as much as fifty percent. For cancer patients that's a big deal, because radiation therapy is time consuming. Patients must get to and from the treatment facility and often must rely on caregivers to provide transportation because they are fatigued, an extremely common side effect of radiation. They also often spend time waiting before being called back for the actual treatment, and can experience delays with treatment delivery because of machine maintenance or breakdowns, staffing shortages, complications with patients, holidays, and other unpredictable factors.

The evidence supporting a hypofractionation regimen for breast cancer and prostate cancer

Long-term studies have confirmed that the use of hypofractionation in breast cancer yields equivalent outcomes as traditional radiation therapy fractionation, with some studies showing improved cosmetic outcomes. Patients receiving hypofractionation also typically experience a better toxicity profile.

Given the benefits, in 2018 the American Society for Radiation Oncology (ASTRO) updated its evidence-based guidelines to recommend hypofractionation as the preferred regimen for women with invasive breast cancer receiving whole breast irradiation. It is also the preferred regimen in the National Comprehensive Cancer Network (NCCN) guidelines.

The ASTRO guidelines from 2018 also include recommendations for prostate cancer, stating that "hypofractionated radiation therapy provides important potential advantages in cost and convenience" for patients with localized prostate cancer.

Some downsides of traditional radiation therapy

Patients who undergo traditional radiation therapy fractionation as part of their treatment regimen receive treatments every weekday for a duration of approximately 6 weeks for breast cancer and upwards of 9 weeks for prostate cancer.

Although the treatments themselves are short—lasting only a few minutes—the overall time it takes to successfully complete a traditional radiation therapy regimen is much longer than treatment via hypofractionation.

Financial stress represents another aspect of the patient treatment burden. For those who must continue working throughout the course of treatment or are eager to return to work as soon as possible, a reduced schedule provides tremendous value.

Hypofractionation is cost-effective but adoption is slow

Hypofractionation's treatment regimen is shorter than traditional radiation therapy and there is strong evidence that it has comparable (and at times superior) efficacy compared to traditional radiation therapy. Hypofractionation is also more cost-effective.

Yet, several studies have shown a relatively slow adoption of hypofractionation for breast cancer and prostate cancer. While there may be a lack of comfort delivering hypofractionation among providers, it's possible that a contributing factor relates to reimbursements. Switching to a shorter regimen reduces overall treatment costs, but for providers typically results in lower revenues because it means they provide fewer services.

According to a 2017 Journal of Clinical Oncology editorial, shifting to hypofractionation results in "a reduction of technical reimbursement by approximately $9,000 per patient—leading to a total reduction of $678,070 for the average radiation oncology department."

Radiation oncology is a complex field and guidelines are often changing. As exciting innovations and supportive data in the field emerges, eviCore can help identify the best and most cost-effective treatment options — and whether treatments like hypofractionation offer the most value to both patients and health plans.