2338 - Environmental Impact of Prostate Radiation Therapy: Modeling Emissions and Reduction Through Hypofractionation
Presenter(s)
J. L. Karten1, A. Asaro2, J. Starner1, A. Narayana1, and K. Lichter3; 1Northwell, New Hyde Park, NY, 2Department of Internal Medicine, Ocean University Medical Center Hackensack Meridian Health, Brick, NJ, 3Department of Radiation Oncology & Applied Sciences, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth Cancer Center, Lebanon, NH
Purpose/Objective(s): Climate change poses growing challenges to healthcare systems, and radiation oncology contributes to greenhouse gas (GHG) emissions through energy-intensive equipment and patient transportation. A previously published Life Cycle Assessment (LCA) established national emissions baselines for external beam radiation therapy (EBRT), including over 37,000 GU patients treated in 2019 (Lichter et al., 2026). Building upon this foundational work, the present study modeled prostate-specific emissions and evaluated the mitigation potential of guideline-concordant hypofractionation.
Materials/Methods: Using previously validated LCA methodology, 2019 National Cancer Database (NCDB) data were analyzed to estimate prostate EBRT volumes. Prostate cancer was estimated to represent 70% of curative GU EBRT cases (n=25,965). Based on NCDB distributions, approximately 65% were categorized as low–intermediate risk disease. Patients receiving conventional fractionation (39 fractions) were modeled for conversion to moderate hypofractionation (28 fractions; RTOG 0415/PROFIT) or stereotactic body radiation therapy (SBRT, 5 fractions; PACE-B/C), consistent with guideline-supported eligibility. Patients already receiving moderate hypofractionation were modeled for SBRT. Emissions were calculated using established LCA inputs including simulation imaging, linear accelerator energy consumption per fraction, on-treatment visits, and patient transportation. Outcomes included total modeled GHG emissions and disability-adjusted life years (DALYs)
Results: Among low–intermediate risk patients treated with conventional fractionation (n=762), total modeled emissions were 15,972 metric tonnes CO2e (4.9 DALYs). Conversion to moderate hypofractionation reduced emissions by 32% relative to conventional schedules. Transition of these patients to SBRT reduced emissions by 77%. Transition of patients already treated with hypofractionation (n=3159) to SBRT still reduced emissions by 66% relative to hypofractionation schedules.
Conclusion: Guideline-concordant hypofractionation reduces modeled emissions from prostate EBRT while aligning with efforts to minimize treatment-related burden. Broader SBRT adoption among eligible patients may reduce emissions by up to 77% relative to conventional schedules. These findings underscore the environmental co-benefits of evidence-based fractionation strategies.