2371 - Implementing Guideline-Directed Hypofractionation at a Satellite Academic Radiation Oncology Center
Presenter(s)
Z. H. Rana1, J. Scott1, A. F. Youssef2, W. Citron3, M. Kim4, J. K. Molitoris1, J. Zhou2, B. Manandhar5, L. M. Douglass1, A. Murphy1, P. Larrimore1, L. Woolsey1, S. H. Allen1, T. O. Tafia1, M. Ferski1, G. H. Windsor1, B. Adams1, J. H. Leverage1, M. Gerrity6, F. A. Young7, S. A. McAvoy1, E. M. Nichols1, W. F. Regine Jr1, and M. V. Mishra1; 1Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 2University of Maryland, Easton, MD, 3University of Maryland, School of Medicine, Baltimore, MD, 4Radiation Oncology Dept, University of Maryland, Baltimore, MD, 5Virginia Commonwealth University, Richmond, VA, 6University of Maryland School of Medicine, Baltimore, MD, 7University of Maryland, Baltimore, MD, United States
Purpose/Objective(s): We evaluated the operational impact of implementing a guideline-directed hypofractionation care pathway in July 2025 at a satellite academic radiation oncology center. We hypothesized that directive-based care would increase stereotactic body radiation therapy (SBRT) utilization and patient access while reducing external beam treatment intensity without compromising departmental productivity or treatment delivery reliability. The primary endpoint was monthly new starts.
Materials/Methods: All patients initiating external beam radiation therapy between July 2024 and December 2025 were included. Operational metrics were analyzed across three predefined six-month intervals: July–December 2024 and January–June 2025 (pre-guideline) versus July–December 2025 (post-guideline). The intervention consisted of a department-wide, guideline-directed hypofractionation pathway prioritizing evidence-based shorter-course regimens. Outcomes included monthly new starts, SBRT treatments, external beam fractions, fractions per start, IMRT utilization, RVUs, and percent of scheduled treatments delivered. Continuous variables were compared using two-sample t-tests. To control for seasonal variation, paired month-to-month comparisons were performed for July–December across years.
Results: Following guideline implementation, mean monthly new starts increased from 35.8±8.8 to 48.0±11.0 (+34%, p=0.019). Mean monthly SBRT treatments increased from 14.6±6.4 to 22.0±5.6 (+51%, p=0.031). Treatment intensity decreased from 20.8 to 14.6 external beam fractions per new start (–30%, p=0.004), corresponding to approximately 1,782 fractions avoided over six months relative to baseline. External beam treatments declined from 760±123 to 701±111 per month (p=0.33), and IMRT utilization decreased from 77.5%±5.3% to 74.5%±3.1% (p=0.21).
When controlling for seasonality using paired July–December comparisons, monthly new starts increased by a mean of 11.5 patients post-guideline, reaching statistical significance (paired p=0.047). Despite fewer fractions per patient, annual RVUs remained stable year-over-year, and =94% of scheduled treatments were delivered with preserved daily throughput.Conclusion: Guideline-directed hypofractionation significantly increased patient access and SBRT utilization while reducing treatment intensity without compromising productivity or delivery reliability at a satellite academic center. Seasonality-controlled analysis confirms that access gains were not driven by calendar effects, supporting directive-based care pathways as a scalable strategy to improve value, efficiency, and access in radiation oncology.