Estimation of the optimal number of radiotherapy fractions for breast cancer: A review of the evidence.
OBJECTIVE
There is variation in radiotherapy fractionation practice, however, there is no evidence-based benchmark for appropriate activity. An evidence-based model was constructed to estimate the optimal number of fractions for the first course of radiotherapy for breast cancer to aid in services planning and performance benchmarking.


METHODS
The published breast cancer radiotherapy utilisation model was adapted. Evidence-based number of fractions was added to each radiotherapy indication. The overall optimal number of fractions was calculated based on the frequency of specific clinical conditions where radiotherapy is indicated and the recommended number of fractions for each condition. Sensitivity analysis was performed to assess the impact of uncertainties on the model.


RESULTS
For the entire Australian breast cancer patient population, the estimated optimal number of fractions per patient was 16.8, 14.6, 13.7 and 0.8 for ductal carcinoma in situ, early, advanced and metastatic breast cancer respectively. Overall, the optimal number of fractions per patient was 14.4 (range 14.4-18.7).


CONCLUSIONS
These results allow comparison with actual practices, and workload prediction to aid in services planning. The model can be easily adapted to other countries by inserting population-specific epidemiological data, and to future changes in cancer incidence, stage distribution and fractionation recommendations.
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW Australia, Sydney, Australia; Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia. Electronic address: karen.wong@sswahs.nsw.gov.au.
Karen
K
Wong
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW Australia, Sydney, Australia; Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; University of Western Sydney, Australia.
Geoff P
GP
Delaney
Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW Australia, Sydney, Australia; Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.
Michael B
MB
Barton
D001315:Australia; D019985:Benchmarking; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence
Breast cancer; Fractions; Optimal; Radiotherapy