TY - JOUR
T1 - Same-day adaptive palliative radiotherapy without prior CT simulation
T2 - Early outcomes in the FAST-METS study
AU - Nelissen, Koen J.
AU - Versteijne, Eva
AU - Senan, Suresh
AU - Rijksen, Barbara
AU - Admiraal, Marjan
AU - Visser, Jorrit
AU - Barink, Sarah
AU - de la Fuente, Amy L.
AU - Hoffmans, Daan
AU - Slotman, Ben J.
AU - Verbakel, Wilko F. A. R.
N1 - Funding Information: This research was funded by a research grant from Varian, a Siemens Healthineers Company (Palo Alto, CA, USA). Verbakel has received honoraria/travel expenses from Varian. Senan has received research funding from Varian and ViewRay Inc. Publisher Copyright: © 2023 The Authors
PY - 2023/5/1
Y1 - 2023/5/1
N2 - 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.
AB - 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.
KW - Adaptive radiotherapy
KW - Clinical implementation
KW - Ethos
KW - Metastases
KW - Palliative radiotherapy
KW - Simulation CT free workflow
UR - http://www.scopus.com/inward/record.url?scp=85148667040&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.radonc.2023.109538
DO - https://doi.org/10.1016/j.radonc.2023.109538
M3 - Article
C2 - 36806603
SN - 0167-8140
VL - 182
JO - Radiotherapy and oncology
JF - Radiotherapy and oncology
M1 - 109538
ER -