Trends in hypofractionation, stereotactic body radiotherapy, metastatic radiotherapy utilization, and plan pricing at a tertiary cancer center: A plan-level analysis (2018–2024).

e23210 Background: Hypofractionation radiotherapy is supported by robust evidence across multiple disease sites, yet real- world adoption patterns, economic implications, and the extent to which changes reflect sustained practice evolution rather than transient responses to the COVID-19 pandemic remain incompletely characterized, particularly in low-middle-income settings. Methods: We conducted a retrospective analysis of all curative and/or ablative external beam radiotherapy courses delivered at a tertiary cancer center between January 2018 and December 2024. Temporal trends in fractionation, metastasis-directed radiotherapy utilization, and radiotherapy plan pricing were evaluated using Spearman correlation, linear regression, generalized additive models, and data- driven change-point analysis. An approximate standardized plan price was derived from institutionally adopted pricing schedules to enable longitudinal comparisons. Results: A total of 10,527 radiotherapy plans delivered to 9,285 patients were analyzed. The mean number of fractions per treatment course declined from 23.4 in 2018 to 17.2 in 2024 (Spearman ρ = −0.93, p = 0.003). Statistically significant reductions were observed for breast, prostate, and colorectal cancers, with disease-specific change-points occurring in 2019–2021. The overall cohort change-point occurred in early 2022, with confidence intervals, excluding March 2020, suggesting that adoption was not temporally driven by COVID-19. The proportion of metastatic radiotherapy plans increased from 8.2% to 19.7% over the study period (ρ = 0.93, p = 0.0025). Among plans with pricing data, the mean radiotherapy plan price declined from approximately 7,299 ± 1,755 USD in 2018 to 6,933 ± 1,976 USD in 2024, corresponding to an average decrease of 83 USD per plan per year (p = 0.015). Pricing for metastatic plans remained stable over time. Conclusions: Hypofractionation and Stereotactic Body Radiotherapy adoption at this high-volume center reflects a sustained, evidence-based evolution in practice across multiple disease sites. This shift was accompanied by increased use of radiotherapy for metastatic disease and a reduction in average plan pricing for high-volume primary cancers, underscoring the role of hypofractionation and Stereotactic Body Radiotherapy in improving treatment efficiency and health- system value in resource-constrained settings.