Practical Guidelines on Implementing Hypofractionated Radiotherapy for Prostate Cancer in Africa.

William Swanson,Luca Incrocci,Ahmed Elzawawy,Richard Ndi Samba,Wilfred Ngwa,Erno Sajo,Michael Lavelle

doi:10.3389/fonc.2021.725103

Abstract

Among a growing body of literature in global oncology, several articles project increased cost savings and radiotherapy access by adopting hypofractionated radiotherapy (HFRT) in low- and middle-income countries (LMICs) like those in Africa. Clinical trials in Europe and the USA have demonstrated HFRT to be non-inferior to conventional radiotherapy for eligible patients with several cancers, including prostate cancer. This could be a highly recommended option to battle a severely large and growing cancer burden in resource-limited regions. However, a level of implementation research may be needed in limited resource-settings like in Africa. In this article, we present a list of evidence-based recommendations to practice HFRT on eligible prostate cancer patients. As literature on HFRT is still developing, these guidelines were compiled from review of several clinical trials and professionally accredited material with minimal resource requirements in mind. HFRT guidelines presented here include patient eligibility, prescription dose schedules, treatment planning and delivery techniques, and quality assurance procedures. The article provides recommendations for both moderately hypofractionated (2.4-3.4Gy per fraction) and ultrahypofractionated (5Gy or more per fraction) radiation therapy when administered by 3D-Conformal Radiotherapy, Intensity Modulated Radiation Therapy, or Image-Guided Radiotherapy. In each case radiation oncology health professionals must make the ultimate judgment to ensure safety as more LMIC centers adopt HFRT to combat the growing scourge of cancer.

Highlights

In 2020, prostate cancer claimed more than 47,000 lives with over 93,000 new cases in Africa (1)
Many clinical trials conducted in Europe and North America have determined recommended parameters to deliver prostate hypofractionated radiotherapy (HFRT) safely with non-inferior outcomes to conventionallyfractionated RT (CFRT) (3–5)
We highlight evidence-based recommendations for performing prostate HFRT, which can serve as uniform guidelines in African low- and middle-income countries (LMICs), with minimal resource requirements in mind and the recognition that additional implementation research may be needed including hypofractionation clinical trials in Africa

Summary

INTRODUCTION

In 2020, prostate cancer claimed more than 47,000 lives with over 93,000 new cases in Africa (1). The 2016-reported phase III CHHIP trial showed 5-year failure free outcomes at 91% for HFRT (60 Gy in 20 fractions) patients and 88% for CFRT (74Gy in 37 fractions) patients (5). Several activity-based-costing models have estimated significant reduction in treatment costs and increase in treatment access by adopting HFRT for eligible patients (7, 8) While, these studies encourage the adoption of HFRT, African low- and middle-income countries (LMICs) clinics may require additional knowledge and resources to perform HFRT safely and effectively (9). We highlight evidence-based recommendations for performing prostate HFRT, which can serve as uniform guidelines in African LMICs, with minimal resource requirements in mind and the recognition that additional implementation research may be needed including hypofractionation clinical trials in Africa. The recommendations in this article were compiled based using evidence-based material including the HFRT clinical trials and professional RT and QA guidelines

MATERIALS AND METHODS

DISCUSSION

Findings

DATA AVAILABILITY STATEMENT