Bush Aaron, Herchko Steven, Chellini Angela, Orande Courtney, Harrell Anna, Wear Michelle, Rutenberg Michael, Attia Albert, Trifiletti Daniel, Peterson Jennifer, May Byron, Vallow Laura, Hoppe Bradford
Mayo Clinic, Jacksonville, Florida.
Adv Radiat Oncol. 2023 Aug 25;9(2):101361. doi: 10.1016/j.adro.2023.101361. eCollection 2024 Feb.
Rapid pain relief for patients with bone metastases can be a challenge due to the lengthy and complex radiation therapy workflow. The purpose of this study was to evaluate the time (in days) between initial radiation oncology consultation and start of palliative radiation treatment after implementing an alternative virtual simulation palliative workflow.
Patients meeting strict criteria were selected for virtual simulation, which included only those with painful bone metastases who were recommended palliative radiation therapy using standard anterior-posterior/posterior-anterior or opposed lateral fields. A recent (within 30 days) diagnostic computed tomography (CT) scan clearly visualizing the target volume was required for treatment planning. For comparison, a reference group of 40 consecutive patients with bone metastases who underwent in-person CT simulation before virtual simulation implementation was reviewed.
Forty-five patients were treated for painful bone metastases as part of the virtual simulation program from May 2021 to October 2022. Regarding travel distance, 23 patients lived locally (<50 miles from the treatment center) and 22 patients were distant (≥50 miles from the treatment center). Average time from consultation to treatment for all patients undergoing virtual simulation was 3.7 days, compared with 7.5 days for patients undergoing in-person CT simulation (3.8 days sooner, on average; ≤ .001). Before full implementation of the virtual simulation program, 5 eligible patients participated in a virtual simulation pilot from April 2021 to May 2021, in which each patient was contoured and planned on both a pre-existing diagnostic CT scan and a standard CT simulation scan. For virtual simulation-based plans, the average V90, V95, and V99 were 99.99%, 99.87%, and 96.70%. No significant planning target volume (PTV) coverage difference was found on subsequent in-person CT simulation scans.
The virtual simulation program decreased the time from consultation to start of treatment by more than 50% for patients recommended palliative radiation therapy for painful bone metastases. This benefit was most significant for outpatients traveling ≥50 miles for treatment. Virtual simulation-based planning can be considered for patients anxious to proceed with radiation therapy quickly or in underserved settings with limited transportation options to regional treatment centers.
由于放射治疗流程冗长复杂，为骨转移患者实现快速疼痛缓解可能具有挑战性。本研究的目的是评估在实施替代性虚拟模拟姑息治疗流程后，从首次放疗肿瘤学会诊到开始姑息性放射治疗之间的时间（以天为单位）。
选择符合严格标准的患者进行虚拟模拟，其中仅包括那些有疼痛性骨转移且被推荐使用标准前后位/后前位或对侧野进行姑息性放射治疗的患者。治疗计划需要近期（30天内）的诊断性计算机断层扫描（CT）扫描清晰显示靶区。为作比较，回顾了在虚拟模拟实施前连续40例接受现场CT模拟的骨转移患者作为参照组。
2021年5月至2022年10月期间，45例患者作为虚拟模拟项目的一部分接受了疼痛性骨转移治疗。关于旅行距离，23例患者居住在当地（距离治疗中心<50英里），22例患者居住在远处（距离治疗中心≥50英里）。所有接受虚拟模拟的患者从会诊到治疗的平均时间为3.7天，而接受现场CT模拟的患者为7.5天（平均早3.8天；P≤0.001）。在虚拟模拟项目全面实施之前，2021年4月至2021年5月期间有5例符合条件的患者参与了虚拟模拟试点，其中每位患者在现有的诊断性CT扫描和标准CT模拟扫描上均进行了轮廓勾画和计划制定。对于基于虚拟模拟的计划，平均V90、V95和V99分别为99.99%、99.87%和96.70%。在随后的现场CT模拟扫描中未发现计划靶区（PTV）覆盖存在显著差异。
对于被推荐接受姑息性放射治疗的疼痛性骨转移患者，虚拟模拟项目将从会诊到开始治疗的时间缩短了50%以上。这一益处对于前往距离≥50英里处接受治疗的门诊患者最为显著。对于急于快速进行放射治疗的患者或交通选择有限、地处偏远地区且难以前往区域治疗中心的患者，可考虑基于虚拟模拟的计划制定。
