Factors influencing the use of hypofractionated radiotherapy in prostate cancer: a nationwide survey of radiation oncologists in Turkiye (TROD 09-008).

purposeTo evaluate contemporary practice patterns in prostate cancer radiotherapy (RT) in Turkiye, with a particular focus on the adoption of hypofractionated and ultrahypofractionated regimens, and to identify factors influencing fractionation preferences among radiation oncologists specialized in uro-oncology.

methodsA cross-sectional, web-based survey consisting of 14 items was distributed to registered members of the Turkish Society for Radiation Oncology (TROD) Uro-Oncology Working Group between September and December 2024. The questionnaire assessed physician demographics, institutional characteristics, technological infrastructure, prostate cancer patient volume, preferred RT fractionation across predefined clinical scenarios, and perceived rationales and barriers to hypofractionation. Descriptive statistics were used to summarize responses, and multivariable logistic regression analysis was performed to identify factors independently associated with hypofractionation use. Analyses were performed using SPSS version 23.0 (IBM Corp., Armonk, NY).

resultsThe survey achieved a response rate of 42.9% (n = 54). Most respondents had ≥ 11 years of clinical experience (96.2%), and 43.7% were employed in private institutions. Advanced RT technologies were widely available, including intensity-modulated radiotherapy (IMRT) (92.6%), volumetric modulated arc therapy (VMAT) (85.2%), stereotactic body radiotherapy (SBRT)-capable platforms (88.9%), and cone-beam computed tomography (CBCT)-based image guidance (85.2%). Hypofractionation was most frequently preferred in low- and intermediate-risk prostate cancer, whereas conventional fractionation predominated in high-risk disease, pelvic irradiation, and adjuvant or salvage settings. In palliative scenarios, hypofractionation was overwhelmingly favored. On multivariable analysis, treating more than 11 new prostate cancer patients per month was independently associated with increased use of hypofractionated RT (p = 0.04).

conclusionsDespite high technological readiness and increasing adoption of hypofractionation among specialized uro-oncology practitioners, Turkish radiation oncologists exhibit caution in high-risk and postoperative settings. Higher clinical volume significantly drives the transition to shorter regimens, suggesting that clinical experience is a key catalyst for closing the evidence-practice gap.