title: The Pattern of Use of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer in New South Wales, Australia, 2008 to 2012.
abstract: Increasing phase 3 evidence has been published about the safety and efficacy of hypofractionated radiation therapy, in comparison with standard fractionation, in early-stage, node-negative breast cancer. However, uptake of hypofractionation has not been universal. The aim of this study was to investigate the hypofractionation regimen variations in practice across public radiation oncology facilities in New South Wales (NSW).
  
  
  
  Patients with early breast cancer registered in the NSW Clinical Cancer Registry who received radiation therapy for early-stage breast cancer in a publicly funded radiation therapy department between 2008 and 2012 were identified. Data extracted and analyzed included dose and fractionation type, patient age at first fraction, address (for geocoding), year of diagnosis, year of treatment, laterality, and department of treatment. A logistic regression model was used to identify factors associated with fractionation type.
  
  
  
  Of the 5880 patients fulfilling the study criteria, 3209 patients (55%) received standard fractionation and 2671 patients (45%) received hypofractionation. Overall, the use of hypofractionation increased from 37% in 2008 to 48% in 2012 (range, 7%-94% across departments). Treatment facility and the radiation oncologist prescribing the treatment were the strongest independent predictors of hypofractionation. Weaker associations were also found for age, tumor site laterality, year of treatment, and distance to facility.
  
  
  
  Hypofractionated regimens of whole breast radiation therapy have been variably administered in the adjuvant setting in NSW despite the publication of long-term trial results and consensus guidelines. Some factors that predict the use of hypofractionation are not based on guideline recommendations, including lower rates of left-sided treatment and increasing distance from a treatment facility.
authors.affiliation: Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; Collaboration for Cancer Outcomes Research and Evaluation, University of New South Wales, Sydney, Australia; Ingham Health and Medical Research Institute, Sydney, Australia; New South Wales Cancer Institute, Australia. Electronic address: Geoff.delaney@swsahs.nsw.gov.au.
authors.forename: Geoff P
authors.initials: GP
authors.lastname: Delaney
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Gandhidasan
authors.affiliation: New South Wales Cancer Institute, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Walton
authors.affiliation: New South Wales Cancer Institute, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Terlich
authors.affiliation: New South Wales Cancer Institute, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Baker
authors.affiliation: New South Wales Cancer Institute, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Currow
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009367:Neoplasm Staging; D009517:New South Wales / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D000069473:Radiation Dose Hypofractionation; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data*; D012042:Registries; D012307:Risk Factors; D055502:Secondary Prevention / Q000706:statistics & numerical data; D014600:Utilization Review