E. MacDuffie1, K. M. M. Rana2, M. Nsingo3, D. Balang3, S. Chiyapo4, K. Bhagat5, M. Kassick6, and S. Grover7,8; 1Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 2Gaborone Private Hospital, Gaborone, Botswana, 3Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana, 4Department of Oncology, Sir Ketumile Masire Teaching Hospital, Gaborone, Botswana, 5Barts and the London School of Medicine and Dentistry, London, United Kingdom, 6University of Pennsylvania, Philadelphia, PA, 7Princess Marina Hospital, Gaborone, Botswana, 8Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s): Physician surveys of fractionation schedules for palliative radiotherapy (pRT) in Africa have reported low utilization of single fraction or hypofractionated regimens despite studies demonstrating clinical efficacy in a number of different clinical scenarios. However, there is a dearth of data describing the real-world patterns of pRT use in low- and middle-income settings. This study aimed to investigate historical patterns of pRT use in Botswana to determine the rate of single and hypofractionated treatment used in this setting. Materials/
Methods: Treatment summaries from patients treated with palliative intent between 2015-2022 were retrospectively collected from the treatment planning system at the sole radiation therapy department in Gaborone, Botswana. Data was analyzed using descriptive statistics and chi-squared tests. Results: Of 8197 recorded prescribed radiotherapy courses, 1735 were delivered with palliative intent and included for analysis. An average of 217 pRT patients (SD 60; range 127-284) were treated per year. Median patient age was 55 years (IQR 44-66). The most frequently treated histologies were cervix (n=355), breast (n=330), prostate (n=122), esophagus (n=84), and lung (n=70). The most frequently treated sites were pelvis (n=546), spine (n=322), head and neck (n=209), brain (n=136), extremities (n=121), upper gastrointestinal (n=80), and chest (n=68). The most frequently prescribed schedules included 1 fraction (n=569, 32.8%), 5 fractions (n=357, 20.6%), 10 fractions (n=346, 19.9%), and 15 fractions (n=89, 5.1%). The proportion of these fraction prescriptions was not significantly different by year. The most frequently prescribed doses included 800 cGy (n=387, 22.3%), 2000 cGy (n=352, 20.2%), 3000 cGy (n=338, 19.5%), and 600 cGy (n=117, 6.74%). Multiple courses were prescribed to 15.2% (n=263) patients (range 2-10). Among all courses, 82.1% (n=1424) delivered the dose prescribed. Conclusion: In Botswana, over one fifth of prescribed radiotherapy courses were delivered with palliative intent. Primary cancer histologies of cervix, breast, and prostate were most common, reflecting the patterns of cancer incidence in the country. Over half pRT courses were delivered in 5 or fewer fractions and were prescribed to 2000 cGy or less. Most pRT patients received the full prescription dose. Notably, the most commonly prescribed regimen was a single fraction, frequently delivering 800 cGy, suggesting that the rate of use of single fraction pRT has been higher in Botswana compared to rates reported in surveys by other African oncologists.
