Schuler Thilo, Roderick Stephanie, Wong Shelley, Kejda Alannah, Grimberg Kylie, Lowe Toby, Kipritidis John, Back Michael, Bergamin Sarah, Carroll Susan, Hruby George, Jayamanne Dasantha, Kneebone Andrew, Lamoury Gillian, Morgia Marita, Stevens Mark, Brown Chris, Gallego Blanca, Porter Brian, Booth Jeremy, Eade Thomas
Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia; Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Int J Radiat Oncol Biol Phys. 2025 Mar 1;121(3):585-595. doi: 10.1016/j.ijrobp.2024.09.041. Epub 2024 Sep 29.
The feasibility of simulation-free radiation therapy (SFRT) has been demonstrated but information regarding its routine care impact and scalability is lacking.
In this single-institution, retrospective cohort study, all patients receiving palliative radiation therapy at an Australian tertiary cancer center were eligible for consideration of SFRT unless mask immobilization, a stereotactic technique, or a definitive dose was indicated. Coprimary endpoints were SFRT utilization, impact on consultation-to-RT time, and on-couch treatment duration. Timing metrics were compared with a contemporary local cohort that received simulation-based palliative radiation therapy using unadjusted Wilcoxon rank-sum tests and a propensity score-matched regression. Electronic patient-reported outcomes 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. Of the 1904 courses, 1000 (52.5% SFRT utilization) received SFRT, including 668 using intensity-modulated radiation therapy/volumetric-modulated arc therapy. A total of 788 individual patients received SFRT and the median age was 71 years (IQR, 61-80) with 59% being male and 42% being Eastern Collaborative Oncology Group 2-4. SFRT utilization increased from 41% to 54% between years 2018-2019 and 2022-2024. SFRT reduced median consultation-to-RT time from 7.0 to 5.1 days (P < .0001) corresponding to an adjusted average treatment effect in the treated of -2.1 days (95% CI, -2.8 to -1.3). SFRT increased median on-couch treatment duration from 17.8 to 20.5 minutes (P < .0001; adjusted average treatment effect in the treated 2.6 minutes, 95% CI, 1.3-3.9). Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events grade 3 acute toxicity was 9% and at 4 weeks after RT, patients with moderate/severe pain at baseline (≥5/10) had a mean pain reduction of 3.5 points (7.1-3.6; P < .0001). CONCLUSIONS: Using widely available technologies, the SFRT-1000 cohort demonstrates routine care scalability with patient-centered 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.
无模拟放射治疗（SFRT）的可行性已得到证实，但缺乏关于其对常规护理影响和可扩展性的信息。
在这项单机构回顾性队列研究中，澳大利亚一家三级癌症中心接受姑息性放射治疗的所有患者，除非需要面罩固定、立体定向技术或确定剂量，均有资格考虑接受SFRT。共同主要终点是SFRT的利用率、对咨询到放疗时间的影响以及治疗台上的治疗持续时间。将时间指标与同时期接受基于模拟的姑息性放射治疗的本地队列进行比较，使用未调整的Wilcoxon秩和检验和倾向得分匹配回归。电子患者报告结局记录了2周的毒性和疼痛反应。
在2018年4月至2024年2月期间，共进行了2849次姑息性放射治疗疗程，其中1904次符合条件。在这1904个疗程中，1000次（SFRT利用率为52.5%）接受了SFRT，其中668次使用了调强放射治疗/容积调强弧形治疗。共有788名个体患者接受了SFRT，中位年龄为71岁（四分位间距，61 - 80岁），59%为男性，42%属于东部肿瘤协作组2 - 4级。2018 - 2019年至2022 - 2024年期间，SFRT利用率从41%提高到54%。SFRT将咨询到放疗的中位时间从7.0天缩短至5.1天（P < .0001），相当于治疗组调整后的平均治疗效果为 - 2.1天（95%置信区间， - 2.8至 - 1.3）。SFRT将治疗台上的中位治疗持续时间从17.8分钟增加到20.
