{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:25:39Z","timestamp":1773897939131,"version":"3.50.1"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gesundheitswesen"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Improving the sustainability and cost-effectiveness\n                        of healthcare systems has become increasingly relevant in times of climate\n                        change, energy transition, an aging population and skyrocketing social\n                        costs. The selection of an adequate fractionation schedule is of fundamental\n                        importance in the field of Radiation Oncology. We evaluated three\n                        internationally established fractionation schedules for definitive prostate\n                        cancer radiation therapy (RT) with respect to their ecological and\n                        health-economic impacts.<\/jats:p><jats:p>We analyzed the data of 109 patients with prostate\n                        cancer, who underwent outpatient radiation therapy at Jena University\n                        Hospital in 2022. After determination of travel distances between their\n                        homes and the treatment facility, carbon dioxide (CO2)-emissions\n                        and taxi costs were calculated for normofractionated RT (39 fractions, A),\n                        moderately hypofractionated RT (20 fractions, B) and ultrahypofractionated\n                        RT (5 fractions, C).<\/jats:p><jats:p>Travel distances of 1616\u2009km (A), 848\u2009km (B) and\n                        242\u2009km (C) were calculated with corresponding costs ranging from 638\u2009\u20ac (C)\n                        to 4255\u2009\u20ac (A). According to the 2024 German physician\u2019s fee schedule,\n                        9,604\u2009\u20ac would be invoiced for medical treatment and transportation in (A),\n                        with transportation costs accounting for 44% of total treatment costs in\n                        normofractionated RT. The travel distance, CO2-emissions and\n                        transportation costs could be reduced by up to 85% by\n                    hypofractionation.<\/jats:p><jats:p>(Ultra-)hypofractionated radiation therapy for\n                        prostate cancer has great potential to lower healthcare costs and reduce\n                        environmental pollution. Given that and the non-inferiority of oncological\n                        outcome and toxicity, hypofractionation should appear beneficial from\n                        patient\u2019s and healthcare provider\u2019s point of view. Current reimbursement\n                        structures seem to be inappropriate regarding increased personnel and\n                        technical efforts required for highly precise dose application and might\n                        hinder comprehensive establishment of ultrahypofraktionated RT in\n                        Germany.<\/jats:p>","DOI":"10.1055\/a-2512-9269","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T23:50:41Z","timestamp":1741218641000},"source":"Crossref","is-referenced-by-count":2,"title":["Travel costs and ecologic imprint associated with different\n                    fractionation schedules in prostate cancer radiotherapy"],"prefix":"10.1055","author":[{"given":"Georg W","family":"Wurschi","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Strahlentherapie und Radioonkologie, Universit\u00e4tsklinikum\n                    Jena, Jena, Germany"},{"name":"Clinician Scientist Programm, Interdisziplin\u00e4res Zentrum f\u00fcr Klinische\n                    Forschung, Universit\u00e4tsklinikum Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Graf","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Strahlentherapie und Radioonkologie, Universit\u00e4tsklinikum\n                    Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffen","family":"Weimann","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Strahlentherapie und Radioonkologie, Universit\u00e4tsklinikum\n                    Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"M\u00e4urer","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Strahlentherapie und Radioonkologie, Universit\u00e4tsklinikum\n                    Jena, Jena, Germany"},{"name":"Clinician Scientist Programm, Interdisziplin\u00e4res Zentrum f\u00fcr Klinische\n                    Forschung, Universit\u00e4tsklinikum Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Straube","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Radioonkologie und Strahlentherapie, Landshut Hospital\n                    Group, Landshut, Germany"},{"name":"Klinik und Poliklinik f\u00fcr RadioOnkologie und Strahlentherapie,\n                    Technische Universit\u00e4t M\u00fcnchen Fakult\u00e4t f\u00fcr Medizin, M\u00fcnchen,\n                    Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Medenwald","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Strahlentherapie, Otto-von-Guericke-Universit\u00e4t Magdeburg\n                    Medizinische Fakult\u00e4t, Magdeburg, Germany"},{"name":"Universit\u00e4tsklinik und Poliklinik f\u00fcr Strahlentherapie,\n                    Universit\u00e4tsklinikum Halle, Halle, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justus","family":"Domschikowski","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Strahlentherapie, University Hospital Schleswig-Holstein \u2013\n                    Campus Kiel, Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"M\u00fcnter","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Strahlentherapie und Radioonkologie, Klinikum Stuttgart,\n                    Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Pietschmann","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Strahlentherapie und Radioonkologie, Universit\u00e4tsklinikum\n                    Jena, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.18444\/5.03.01.0005.0017.0001","article-title":"Datenbankabfrage mit Sch\u00e4tzung der Inzidenz, Pr\u00e4valenz und des \u00dcberlebens von\n                    Krebs in Deutschland auf Basis der epidemiologischen Landeskrebsregisterdaten\n                    In, Mortalit\u00e4tsdaten bereitgestellt vom Statistischen Bundesamt","year":"2022","journal-title":"Zentrum f\u00fcr Krebsregisterdaten im Robert\n                    Koch-Institut;"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.6004\/jnccn.2023.0050","article-title":"Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in\n                    Oncology","volume":"21","author":"E M Schaeffer","year":"2023","journal-title":"Journal of the National Comprehensive Cancer Network"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1016\/s1470-2045(16)30102-4","article-title":"Conventional versus hypofractionated high-dose intensity-modulated radiotherapy\n                    for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3\n                    CHHiP trial","volume":"17","author":"D Dearnaley","year":"2016","journal-title":"Lancet Oncol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1016\/S1470-2045(16)30070-5","article-title":"Hypofractionated versus conventionally fractionated radiotherapy for patients\n                    with localised prostate cancer (HYPRO): final efficacy results from a\n                    randomised, multicentre, open-label, phase 3 trial","volume":"17","author":"L Incrocci","year":"2016","journal-title":"The Lancet Oncology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2325","DOI":"10.1200\/JCO.2016.67.0448","article-title":"Randomized Phase III Noninferiority Study Comparing Two Radiotherapy\n                    Fractionation Schedules in Patients With Low-Risk Prostate Cancer","volume":"34","author":"W R Lee","year":"2016","journal-title":"Journal of Clinical Oncology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00066-016-1041-5","article-title":"Hypofractionated radiotherapy for localized prostate cancer","volume":"193","author":"S H\u00f6cht","year":"2017","journal-title":"Strahlenther Onkol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1097\/ju.0000000000002758","article-title":"Clinically Localized Prostate Cancer: AUA\/ASTRO Guideline, Part II: Principles\n                    of Active Surveillance, Principles of Surgery, and Follow-Up","volume":"208","author":"J A Eastham","year":"2022","journal-title":"J Urol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"963","DOI":"10.3109\/0284186X.2012.719635","article-title":"Prostate alpha\/beta revisited \u2013 an analysis of clinical results from 14 168\n                    patients","volume":"51","author":"A Dasu","year":"2012","journal-title":"Acta Oncologica"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/s1470-2045(20)30581-7","article-title":"Ultra-hypofractionated versus conventionally fractionated radiotherapy for\n                    prostate cancer (HYPO-RT-PC): patient-reported quality-of-life outcomes of a\n                    randomised, controlled, non-inferiority, phase 3 trial","volume":"22","author":"P Fransson","year":"2021","journal-title":"Lancet Oncol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1016\/S1470-2045(22)00517-4","article-title":"Intensity-modulated radiotherapy versus stereotactic body radiotherapy for\n                    prostate cancer (PACE-B): 2-year toxicity results from an open-label,\n                    randomised, phase 3, non-inferiority trial","volume":"23","author":"A C Tree","year":"2022","journal-title":"The Lancet Oncology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1016\/s1470-2045(19)30569-8","article-title":"Intensity-modulated fractionated radiotherapy versus stereotactic body\n                    radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an\n                    international, randomised, open-label, phase 3, non-inferiority trial","volume":"20","author":"D H Brand","year":"2019","journal-title":"Lancet Oncol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/s00066-020-01723-8","article-title":"Ultrahypofractionation of localized prostate cancer","volume":"197","author":"F Wolf","year":"2021","journal-title":"Strahlentherapie und Onkologie"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"103661","DOI":"10.1016\/j.critrevonc.2022.103661","article-title":"Highly hypofractionated schedules for localized prostate cancer: Recommendations\n                    of the GETUG radiation oncology group","volume":"173","author":"A Lapierre","year":"2022","journal-title":"Crit Rev Oncol Hematol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.ijrobp.2018.05.040","article-title":"Multicenter Trial of Stereotactic Body Radiation Therapy for Low- and\n                    Intermediate-Risk Prostate Cancer: Survival and Toxicity Endpoints","volume":"102","author":"R M Meier","year":"2018","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/S0140-6736(19)31131-6","article-title":"Ultra-hypofractionated versus conventionally fractionated radiotherapy for\n                    prostate cancer: 5-year outcomes of 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spine\n                    metastases","author":"M Guckenberger","year":"2024","journal-title":"Radiotherapy and Oncology"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1016\/j.annonc.2021.07.016","article-title":"EANO\u2013ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of\n                    patients with brain metastasis from solid tumours","volume":"32","author":"E Le Rhun","year":"2021","journal-title":"Annals of Oncology"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.radonc.2022.05.024","article-title":"ESTRO ACROP guidelines for external beam radiotherapy of patients with\n                    uncomplicated bone metastases","volume":"173","author":"J van der Velden","year":"2022","journal-title":"Radiotherapy and Oncology"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1016\/j.ijrobp.2008.10.091","article-title":"Higher-than-conventional radiation doses in localized prostate cancer treatment:\n                    a meta-analysis of randomized, controlled trials","volume":"74","author":"G A Viani","year":"2009","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"101405","DOI":"10.1016\/j.adro.2023.101405","article-title":"Intrafraction Motion and Margin Assessment for Ethos Online Adaptive\n                    Radiotherapy Treatments of the Prostate and Seminal Vesicles","volume":"9","author":"M Byrne","year":"2024","journal-title":"Adv Radiat Oncol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1016\/S1470-2045(19)30569-8","article-title":"Intensity-modulated fractionated radiotherapy versus stereotactic body\n                    radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an\n                    international, randomised, open-label, phase 3, non-inferiority trial","volume":"20","author":"D H Brand","year":"2019","journal-title":"The Lancet Oncology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/S1470-2045(20)30581-7","article-title":"Ultra-hypofractionated versus conventionally fractionated radiotherapy for\n                    prostate cancer (HYPO-RT-PC): patient-reported quality-of-life outcomes of a\n                    randomised, controlled, non-inferiority, phase 3 trial","volume":"22","author":"P Fransson","year":"2021","journal-title":"The Lancet Oncology"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1056\/NEJMoa2403365","article-title":"Phase 3 Trial of Stereotactic Body Radiotherapy in Localized Prostate\n                    Cancer","volume":"391","author":"N van As","year":"2024","journal-title":"New England Journal of Medicine"}],"container-title":["Das Gesundheitswesen"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2512-9269.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T00:37:32Z","timestamp":1744418252000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2512-9269"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,5]]},"references-count":25,"URL":"https:\/\/doi.org\/10.1055\/a-2512-9269","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0941-3790","1439-4421"],"issn-type":[{"value":"0941-3790","type":"print"},{"value":"1439-4421","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,5]]}}}