Adoption of Hypofractionated Radiation Therapy and Quality of Life Outcomes for Localised Prostate Cancer in an Australian Population‐Based Cohort

OBJECTIVES: We aimed to evaluate the adoption of hypofractionated radiotherapy (HFRT) for localised prostate cancer (PCa) and the quality of life (QOL) outcomes at a population-based level in Victoria. METHODS: This is a population-based cohort of individuals with PCa registered in the Victorian Prostate Cancer Outcomes Registry (PCOR-Vic) who had radiotherapy between 2016 and 2023. The primary outcomes were the proportion of individuals who had HFRT, and QOL 12 months post-treatment assessed using the EPIC26 questionnaire. Multivariable logistic regressions were used to evaluate factors associated with HFRT use, and linear regressions were used to estimate differences in EPIC26 domain scores between HFRT and conventional fractionated radiotherapy (CFRT). RESULTS: There were 3647 individuals included in the study-213 (6%) low-risk PCa, 1799 (49%) intermediate-risk PCa, and 1635 (45%) high-risk PCa. There were 1729 (47%) individuals who had HFRT. The use of HFRT increased from 2% for the whole cohort in 2016 to 87% for low-intermediate risk PCa and 52% for high-risk PCa in 2023. In multivariable analyses, increased age, low-intermediate risk PCa, and more recent years of treatment were independently associated with treatment with HFRT. Among individuals who completed the 12-month post-treatment EPIC26 questionnaire, no statistically or clinically significant differences in urinary and bowel QOL outcomes were observed between HFRT and CFRT. CONCLUSION: There was a significant increase in the adoption of HFRT in this contemporaneous population-based cohort of individuals who had radiotherapy for localised PCa in Victoria. At a population-based level, there was no evidence of differences in QOL outcomes at 12 months after HFRT and CFRT.