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Radiat Oncol J. 2017 Jun;35(2):137-143. doi: 10.3857/roj.2017.02026. Epub 2017 Jun 30.

Stereotactic radiotherapy of the prostate: fractionation and utilization in the United States.

Author information

1
Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA.
2
Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, USA.
3
Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.

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 725 cGy × 5 fractions (49.6%) followed by 700 cGy × 5 fractions (21.3%).

CONCLUSIONS:

Extreme hypofractionation via SBRT is slowly increasing acceptance. Currently 700-725 cGy × 5 fractions 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.

KEYWORDS:

Fractionation; National Cancer Database; Prostate cancer; Stereotactic body radiation therapy; Utilization

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