Same-day adaptive palliative radiotherapy without prior CT simulation: Early outcomes in the FAST-METS study

Koen J Nelissen; Eva Versteijne; Suresh Senan; Barbara Rijksen; Marjan Admiraal; Jorrit Visser; Sarah Barink; Amy L de la Fuente; Daan Hoffmans; Ben J Slotman; Wilko F A R Verbakel

doi:10.1016/j.radonc.2023.109538

Same-day adaptive palliative radiotherapy without prior CT simulation: Early outcomes in the FAST-METS study

Radiother Oncol. 2023 May:182:109538. doi: 10.1016/j.radonc.2023.109538. Epub 2023 Feb 16.

Affiliations

¹ Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands. Electronic address: k.j.nelissen@amsterdamumc.nl.
² Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
³ Amsterdam UMC location Vrije Universiteit Amsterdam, Radiation Oncology, Amsterdam, the Netherlands.

PMID: 36806603
DOI: 10.1016/j.radonc.2023.109538

Abstract

Background and purpose: Standard palliative radiotherapy workflows involve waiting times or multiple clinic visits. We developed and implemented a rapid palliative workflow using diagnostic imaging (dCT) for pre-planning, with subsequent on-couch target and plan adaptation based on a synthetic computed tomography (CT) obtained from cone-beam CT imaging (CBCT).

Materials and methods: Patients with painful bone metastases and recent diagnostic imaging were eligible for inclusion in this prospective, ethics-approved study. The workflow consisted of 1) telephone consultation with a radiation oncologist (RO); 2) pre-planning on the dCT using planning templates and mostly intensity-modulated radiotherapy; 3) RO consultation on the day of treatment; 4) CBCT scan with on-couch adaptation of the target and treatment plan; 5) delivery of either scheduled or adapted treatment plan. Primary outcomes were dosimetric data and treatment times; secondary outcome was patient satisfaction.

Results: 47 patients were enrolled between December 2021 and October 2022. In all treatments, adapted treatment plans were chosen due to significant improvements in target coverage (PTV/CTV V95%, p-value < 0.005) compared to the original treatment plan calculated on daily anatomy. Most patients were satisfied with the workflow. The average treatment time, including consultation and on-couch adaptive treatment, was 85 minutes. On-couch adaptation took on average 30 min. but was longer in cases where the automated deformable image registration failed to correctly propagate the targets.

Conclusion: A fast treatment workflow for patients referred for painful bone metastases was implemented successfully using online adaptive radiotherapy, without a dedicated CT simulation. Patients were generally satisfied with the palliative radiotherapy workflow.

Keywords: Adaptive radiotherapy; Clinical implementation; Ethos; Metastases; Palliative radiotherapy; Simulation CT free workflow.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cone-Beam Computed Tomography / methods
Humans
Prospective Studies
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / methods
Radiotherapy, Image-Guided* / methods
Radiotherapy, Intensity-Modulated* / methods
Referral and Consultation
Telephone