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One week of breast radiotherapy in five doses works as well as three weeks in fifteen, but clinics paid per dose lose money by switching; paying one price per course removes the penalty.
FAST-Forward (Lancet 2020) showed 26 Gy in five fractions over one week was non-inferior to 40 Gy in fifteen fractions for local recurrence after breast surgery. Prostate, rectal, lung and palliative bone regimens have similar evidence. Fee-for-fraction payment makes the shorter course a revenue loss for the centre. Medicare's Radiation Oncology Model proposed episode payments; a simpler per-course rate for the common sites would align the incentive with the evidence.
Shares Knowledge reaches practice too slowly, Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
Shares Incentives reward me-too drugs and marginal gains, Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
Shares American Society for Radiation Oncology, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
Shares American Society for Radiation Oncology, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
Shares American Society for Radiation Oncology, IMRT / IGRT (modern external beam), Prostate cancer.
Shares Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial, IMRT / IGRT (modern external beam), HR-positive / HER2-negative breast cancer.
Shares SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam), Prostate cancer.
Shares SBRT / SABR (stereotactic radiotherapy), HR-positive / HER2-negative breast cancer.