The year in fractions.

Top Line: How and why did radiation fractionation schemes change in 2020?

The Study: Here’s an interesting look at the UK where the number of total radiation courses was down 20% in April 2020 versus the same time last year, primarily due to a nearly 3/4 reduction in the number of patients treated for prostate or non-melanoma skin cancers. The number of total treatments was down 30% in April - June, largely due to that plus an incredible increase in the proportion of breast cancers treated with 5 fractions. Five-fraction breast radiation went from 0.2% in 2019 to 61% in 2020—in other words, from virtually none to a majority in the span of a few months. That may be worth reading again as a truly remarkable feat. Why? One contributor may have been the institution of “block” monthly payments during the pandemic (versus the previous pay-per-treatment model). And another may have been prior experience with the 5-fraction technique after participation in the national FAST-FORWARD trial. A final interesting note is the relative increase in definitive treatments for rectal (36%), esophageal (41%), and bladder (64%) cancers all presumably performed in lieu of surgery.

TBL: [in BBC voice] “The pandemic has beneficially catalysed the adoption of a new evidence base.” | Spencer, Lancet Oncol 2021

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