Saving lives, saving earth: hypofractionation and carbon footprint.

Purpose: The healthcare system contributes approximately 5% of global greenhouse gas emissions, yet the environmental impact of radiotherapy treatments remains inadequately assessed.

Material And Methods: We selected all breast cancer patients (1959 patients) treated with adjuvant radiotherapy between 2015 and 2023 in one institution. We analyzed the CO emissions associated with travel. We also selected 60 patients randomly to analyze treatment-associated carbon emissions. We compared three different fractionation schemes: normofractionation (25-30 fractions, fx), hypofractionation (15-18fx), and ultra-hypofractionation (5-6fx).

Results: Our study revealed a significant reduction in carbon emissions within the 5-fractions group compared to the 15-fractions group (26.69kg vs 57.13kg, p < 0.001), saving approximately the CO emissions associated with the electricity consumption of an average Spanish household for 12 days, or the emissions of a passenger flying from Madrid to Barcelona.

Conclusion: Most of the carbon footprint of radiotherapy is due to travel. Hypofractionation could be an appropriate solution to protect the environment.