Real-world implementation of simulation-free radiotherapy (SFRT-1000): A propensity score-matched analysis of 1000 consecutive palliative courses delivered in routine care.

Journal

International journal of radiation oncology, biology, physics
ISSN: 1879-355X
Titre abrégé: Int J Radiat Oncol Biol Phys
Pays: United States
ID NLM: 7603616

Informations de publication

Date de publication:
25 Sep 2024
Historique:
received: 08 07 2024
revised: 09 09 2024
accepted: 23 09 2024
medline: 3 10 2024
pubmed: 3 10 2024
entrez: 1 10 2024
Statut: aheadofprint

Résumé

The feasibility of simulation-free radiotherapy (SFRT) has been demonstrated but information regarding its routine care impact and scalability is lacking.  METHODS: In this single institution retrospective cohort study, all patients receiving palliative radiotherapy (RT) at an XXX tertiary cancer centre were eligible for consideration of SFRT unless mask immobilisation, a stereotactic technique, or a definitive dose was indicated. Co-primary endpoints were SFRT utilisation, impact on consultation-to-RT time and on-couch treatment duration. Timing metrics were compared to a contemporary local cohort that received simulation-based palliative RT using unadjusted Wilcoxon rank-sum tests and a propensity score-matched regression. Electronic patient-reported outcomes (ePROs) captured 2-week toxicity and pain response.  RESULTS: Between April 2018 and February 2024, 2849 palliative radiation courses were delivered, of which 1904 were eligible. 1000 of the 1904 courses (52.5% SFRT utilisation) received SFRT, including 668 using IMRT/VMAT. 788 individual patients received SFRT and the median age was 71 years (IQR 61 - 80) with 59% being male and 42% being ECOG 2-4. SFRT utilization increased from 41% to 54% between years 2018-19 and 2022-24.  SFRT reduced median consultation-to-RT time from 7.0 to 5.1 days (p<0.0001) corresponding to an adjusted average treatment effect in the treated (aATT) of -2.1 days (95%CI -2.8 to -1.3). SFRT increased median on-couch treatment duration from 17.8min to 20.5min (p<0.0001; aATT 2.6min, 95%CI 1.3 to 3.9). PRO-CTCAE grade 3 acute toxicity was 9% and at 4 weeks post RT patients with moderate/severe pain at baseline (≥ 5/10) had a mean pain reduction of 3.5 points (7.1 to 3.6; p<0.0001).  CONCLUSIONS: Using widely available technologies the SFRT-1000 cohort demonstrates routine care scalability with patient-centred and workflow benefits. SFRT is an attractive new paradigm implementable in most settings following adaptation to local requirements. Thus, SFRT opens new avenues to potentially improve access to palliative RT, which remains a global area of need.

Sections du résumé

BACKGROUND BACKGROUND
The feasibility of simulation-free radiotherapy (SFRT) has been demonstrated but information regarding its routine care impact and scalability is lacking.  METHODS: In this single institution retrospective cohort study, all patients receiving palliative radiotherapy (RT) at an XXX tertiary cancer centre were eligible for consideration of SFRT unless mask immobilisation, a stereotactic technique, or a definitive dose was indicated. Co-primary endpoints were SFRT utilisation, impact on consultation-to-RT time and on-couch treatment duration. Timing metrics were compared to a contemporary local cohort that received simulation-based palliative RT using unadjusted Wilcoxon rank-sum tests and a propensity score-matched regression. Electronic patient-reported outcomes (ePROs) captured 2-week toxicity and pain response.  RESULTS: Between April 2018 and February 2024, 2849 palliative radiation courses were delivered, of which 1904 were eligible. 1000 of the 1904 courses (52.5% SFRT utilisation) received SFRT, including 668 using IMRT/VMAT. 788 individual patients received SFRT and the median age was 71 years (IQR 61 - 80) with 59% being male and 42% being ECOG 2-4. SFRT utilization increased from 41% to 54% between years 2018-19 and 2022-24.  SFRT reduced median consultation-to-RT time from 7.0 to 5.1 days (p<0.0001) corresponding to an adjusted average treatment effect in the treated (aATT) of -2.1 days (95%CI -2.8 to -1.3). SFRT increased median on-couch treatment duration from 17.8min to 20.5min (p<0.0001; aATT 2.6min, 95%CI 1.3 to 3.9). PRO-CTCAE grade 3 acute toxicity was 9% and at 4 weeks post RT patients with moderate/severe pain at baseline (≥ 5/10) had a mean pain reduction of 3.5 points (7.1 to 3.6; p<0.0001).  CONCLUSIONS: Using widely available technologies the SFRT-1000 cohort demonstrates routine care scalability with patient-centred and workflow benefits. SFRT is an attractive new paradigm implementable in most settings following adaptation to local requirements. Thus, SFRT opens new avenues to potentially improve access to palliative RT, which remains a global area of need.

Identifiants

DOI: 10.1016/j.ijrobp.2024.09.041 PMID: 39353478
pubmed: 39353478
pii: S0360-3016(24)03413-8
doi: 10.1016/j.ijrobp.2024.09.041
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Conflicts of Interest Notification Actual or potential conflicts of interest do not exist.

Auteurs

Thilo Schuler (T)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia. Electronic address: thilo.schuler@health.nsw.gov.au.

Stephanie Roderick (S)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia.

Shelley Wong (S)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia.

Alannah Kejda (A)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia.

Kylie Grimberg (K)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia.

Toby Lowe (T)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia.

John Kipritidis (J)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW Australia.

Michael Back (M)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia.

Sarah Bergamin (S)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia.

Susan Carroll (S)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia.

George Hruby (G)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia.

Dasantha Jayamanne (D)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia.

Andrew Kneebone (A)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia.

Gillian Lamoury (G)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia.

Marita Morgia (M)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia.

Mark Stevens (M)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia.

Chris Brown (C)

NHMRC Clinical Trials Centre, University of Sydney, Sydney NSW, Australia. Electronic address: c.brown@sydney.edu.au.

Blanca Gallego (B)

Centre for Big Data Research in Health, University of New South Wales, Sydney NSW, Australia.

Brian Porter (B)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia.

Jeremy Booth (J)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW Australia.

Thomas Eade (T)

Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney NSW, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia.

Classifications MeSH