Caring for patients, caring for the planet: extreme hypofractionated curative radiotherapy in the Green Era A Pilot study within the MUSA framework.

Abstract

Concern about rising greenhouse gas levels is increasing, and the healthcare sector represents a substantial contributor to global carbon footprints. As a result, the development of more sustainable oncology practices has become an urgent call to action. Since more than half of cancer patients receive radiation therapy (RT), understanding its potential environmental impact is essential. The aim of the present study is to estimate the carbon footprint produced by RT in the context of prostate cancer comparing moderate and extreme hypofractionated treatments. Activity data for 100 prostate cancer patients treated with Varian Trilogy linear accelerator system were collected. Half of them underwent moderate hypofractionated RT (26 fractions) and half extreme hypofractionated RT (5 fractions). For each patient, the RT-related carbon footprint was calculated and differences between the two schedules were analyzed. The median carbon footprint for a moderate and an extreme hypofractionated treatment was 972.55 kgCO2e and 402.85 kgCO2e, respectively. The carbon footprint of extreme hypofractionated treatments was statistically lower compared to moderate hypofractionated treatments (p < 0.00001). Assuming that everyone traveled in an average-sized petrol car, the carbon footprint for patient travel represented the primary source of the carbon footprint, accounting for 81.3% and 91.6% of the total carbon footprint. These initial findings highlight that the biggest contributor to RT carbon footprint was patient travel. This result suggests how the adoption of extreme hypofractionated treatments may represent a possible way to reduce RT carbon footprint.