Practice pattern survey Of breaSt cancer radIoTherapy among Indian Radiation ONcologists (POSITRON)- A Pilot Survey

Abstract

Introduction: Breast cancer radiotherapy has evolved from conventional fractionation to hypofractionated and ultra-hypofractionated schedules, accelerated further during the COVID-19 pandemic. However, implementing such techniques in India may be limited by financial and technological constraints. Real-world adoption patterns in India remain inadequately documented. This study aimed to evaluate current practice patterns of breast cancer radiotherapy among Indian radiation oncologists, with particular focus on dose fractionation, techniques, and factors influencing clinical decision-making.

Materials and Methods: A 50-question cross-sectional e-survey was developed using Google Forms and distributed to radiation oncologists via email and academic discussion groups. The questionnaire contained 22 open-ended and 28 multiple-choice questions. Descriptive statistics were used to summarize responses, and exploratory comparisons were performed using Fisher’s exact test where appropriate.

Results: Forty-five eligible responses were analysed out of fifty received responses. Hypofractionation (40 Gy/15#) was the preferred regimen for post-mastectomy RT (69%), whole breast RT (69%), WBRT-DCIS (64%), and regional nodal irradiation (69%). Ultra-hypofractionation (26 Gy/5#) was used by 38%. 3DCRT was the most preferred technique for PMRT and WBRT. DIBH was routinely used by 58% in left-sided breast cancer. Respondents with access to a motion management facility reported adopting lower target mean heart dose thresholds for left-sided cases. Perceived toxicity and cosmetic outcomes were more favourable with hypo-fractionated regimens.

Conclusion: This pilot survey provides a preliminary snapshot of contemporary breast radiotherapy practices among a limited cohort of Indian radiation oncologists. Moderate hypofractionation is widely adopted, while ultra-hypofractionation remains selectively used. Larger, nationally representative surveys are required to define definitive practice patterns.