随机临床试验已证明，对于局限性前列腺癌患者，较短的放疗 (RT) 疗程（称为大分割）与较长的放疗疗程相比具有非劣效性。尽管较短的课程与成本效益、便利性和扩大放疗的使用范围相关，但它们的采用情况仍然存在差异。为了确定美国目前体外束放疗治疗前列腺癌的实践模式。这项队列研究从国家癌症数据库中获取了数据，该机构从 1500 多家经认可的美国机构收集了大约 72% 的美国癌症患者的医院登记数据。如果患者在 2004 年至 2020 年间诊断出患有局限性前列腺癌并接受了具有治愈目的的外照射放疗，则患者将被纳入样本。分析于 2023 年 2 月至 3 月期间进行。放疗计划，分为超低分割（≤7 次分割）、中度大分割（20-30 次分割）和常规分割（31-50 次分割）。RT 分割计划中的纵向模式是主要结果。进行多变量逻辑回归来评估与较短 RT 课程相关的变量。协变量包括年龄、国家综合癌症网络风险组、农村地区、种族、设施位置、设施类型、收入中位数、保险类型或状态以及 Charlson-Deyo 合并症指数。 共有 313 062 名局限性前列腺癌患者（平均 [SD ] 年龄，68.8 [7.7] 岁）被纳入分析。接受传统分割的患者比例呈时间模式下降，从 2004 年的 76.0% 下降到 2020 年的 36.6%（趋势 P <.001）。从 2004 年到 2020 年，中度大分割的使用率从 22.0% 增加到 45.0%（趋势 P <.001），超大分割的使用率从 2.0% 增加到 18.3%（趋势 P <.001）。到 2020 年，最常见的放疗方案是低风险组患者的超大分割治疗和中风险组患者的中度大分割治疗。在多变量分析中，社区癌症计划的治疗（与学术或研究计划相比；比值比 [OR]，0.54 [95% CI，0.52-0.56]；P < .001）、医疗补助保险（与 Medicare 相比；OR， 1.49 [95% CI, 1.41-1.57]; P < .001)，黑人种族（与白人种族相比；OR, 0.90 [95% CI, 0.87-0.92]；P < .001），收入中位数较高（与白人种族相比）中位收入较低；OR，1.28 [95% CI，1.25-1.31]；P < .001）与接受较短疗程的 RT 相关。该队列研究的结果显示，短期 RT 疗程的使用有所增加2004年至2020年前列腺癌；健康问题的一些社会决定因素似乎与较短疗程的采用减少有关。可能有必要重新调整报销模式，以便更广泛地采用超低分割，以支持技术采购成本。

Randomized clinical trials have demonstrated the noninferiority of shorter radiotherapy (RT) courses (termed hypofractionation) compared with longer RT courses in patients with localized prostate cancer. Although shorter courses are associated with cost-effectiveness, convenience, and expanded RT access, their adoption remains variable.To identify the current practice patterns of external beam RT for prostate cancer in the US.This cohort study obtained data from the National Cancer Database, which collects hospital registry data from more than 1500 accredited US facilities on approximately 72% of US patients with cancer. Patients were included in the sample if they had localized prostate adenocarcinoma that was diagnosed between 2004 and 2020 and underwent external beam RT with curative intent. Analyses were conducted between February and March 2023.Radiotherapy schedules, which were categorized as ultrahypofractionation (≤7 fractions), moderate hypofractionation (20-30 fractions), and conventional fractionation (31-50 fractions).Longitudinal pattern in RT fractionation schedule was the primary outcome. Multivariable logistic regression was performed to evaluate the variables associated with shorter RT courses. Covariables included age, National Comprehensive Cancer Network risk group, rurality, race, facility location, facility type, median income, insurance type or status, and Charlson-Deyo Comorbidity Index.A total of 313 062 patients with localized prostate cancer (mean [SD] age, 68.8 [7.7] years) were included in the analysis. There was a temporal pattern of decline in the proportion of patients who received conventional fractionation, from 76.0% in 2004 to 36.6% in 2020 (P for trend <.001). From 2004 to 2020, use of moderate hypofractionation increased from 22.0% to 45.0% (P for trend <.001), and use of ultrahypofractionation increased from 2.0% to 18.3% (P for trend <.001). By 2020, the most common RT schedule was ultrahypofractionation for patients in the low-risk group and moderate hypofractionation for patients in the intermediate-risk group. On multivariable analysis, treatment at a community cancer program (compared with academic or research program; odds ratio [OR], 0.54 [95% CI, 0.52-0.56]; P < .001), Medicaid insurance (compared with Medicare; OR, 1.49 [95% CI, 1.41-1.57]; P < .001), Black race (compared with White race; OR, 0.90 [95% CI, 0.87-0.92]; P < .001), and higher median income (compared with lower median income; OR, 1.28 [95% CI, 1.25-1.31]; P < .001) were associated with receipt of shorter courses of RT.Results of this cohort study showed an increase in the use of shorter courses of RT for prostate cancer from 2004 to 2020; a number of social determinants of health appeared to be associated with reduced adoption of shorter treatment courses. Realignment of reimbursement models may be necessary to enable broader adoption of ultrahypofractionation to support technology acquisition costs.