{"entity":{"id":"idea-acc-hypofractionation-default-lmic","kind":"idea","name":"Make one-week radiotherapy the default in overloaded systems","aka":[],"tldr":"Giving radiotherapy in five larger doses over one week instead of 15 to 25 smaller doses is non-inferior for cancer control and late toxicity in breast and prostate cancer, and triples the number of patients each machine can treat. The barriers are guideline inertia and payment per fraction, not hardware.","summary":"Randomised trials (FAST-Forward in breast, several in prostate) show that ultra-hypofractionated schedules are non-inferior for cancer control and late toxicity. In systems where the queue for a machine is the limiting factor, adopting these schedules as the national default protocol is the fastest capacity gain available, without any new hardware. The barrier is guideline inertia and fee-for-fraction payment.","asOf":"2026-09-08","links":[{"label":"FAST-Forward trial (Lancet 2020)","url":"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30932-6/fulltext"}],"tags":[],"related":[],"cancers":["breast-hr-positive","prostate"],"sections":["radiation"],"technologies":["imrt-igrt","sbrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-global-access","b-surgery-radiation-innovation","b-knowledge-diffusion"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"National adoption of five-fraction breast and prostate protocols in a country with fewer than one machine per million people will increase the number of patients starting radiotherapy within 30 days of referral by at least 50% within 18 months.","rationale":"Machine throughput scales inversely with fraction number; the evidence base is Level 1 and the schedules are simpler for patients who travel long distances. Fee-for-fraction reimbursement is the main disincentive and can be changed by decree.","test":"A stepped-wedge national rollout with per-centre audit of fraction numbers, waiting times, and two-year local-control and toxicity outcomes against the pre-rollout cohort.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-acc-hypofractionation-default-lmic/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"technology":[{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"bottleneck":[{"id":"b-knowledge-diffusion","kind":"bottleneck","name":"Knowledge reaches practice too slowly","route":"/bottlenecks/b-knowledge-diffusion/"},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"roadmap":[{"id":"global-access-roadmap","kind":"roadmap","name":"Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation","route":"/roadmaps/global-access-roadmap/"},{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"}]}}