Comparing Rapid Palliative Ig-Imrt With More Conventional Simulation And Treatment Approaches

Purpose/Objective(s)To evaluate the feasibility of using an integrated imaging, planning, and treatment delivery system to deliver IG-IMRT for patients requiring urgent palliative radiotherapy (PRT).Materials/MethodsBetween December 2006 and February 2008, 23 patients requiring urgent PRT were selected to undergo single-session MV-CT simulation, IMRT treatment planning, and delivery of the first fraction of radiotherapy on a helical Tomotherapy unit. The time required to complete each step was recorded along with the overall time spent in the treatment room. This was compared to the time required for our standard approach for PRT with either fluoroscopic or CT-based simulation, simple treatment planning, and treatment on a megavoltage machine (Cobalt-60 unit or 6 MV linac). The IMRT distributions were compared with the more conventional treatments plans that would normally be used.ResultsTwenty-three patients were treated with our integrated IG-IMRT protocol. The median age was 72 years, with 61% men and 39% women. The indications for PRT were as follows: 66% for painful bone metastases, 17% for bleeding, and 17% for other reasons. The average time required for the various processes was as follows: 15 minutes for MV-CT acquisition, 16 minutes for target volume delineation, 9 minutes for IMRT planning, 10 minutes for the repeat verification MV-CT, and 12 minutes for delivery of the first radiotherapy fraction. The average total time spent in the treatment room by patients was 62 minutes, and this decreased during the course of the study from over 90 minutes initially to approximately 60 minutes. The average time for our standard approach for simulation and immediate treatment for patients requiring urgent PRT with either fluoroscopy or conventional CT-simulation was 59 minutes and 92 minutes, respectively, and this excludes the time required to transfer patients between rooms and the waiting time between simulation and treatment. The IMRT dose distributions were more conformal than with the conventional approaches; with a more homogeneous dose to the target volume and a marked reduction in hotspots. This protocol was used for patients requiring single-fraction (8 patients) and short-course (15 patients receiving 2-5 fractions) PRT. The delivery quality assurance (DQA) done following the first fraction of treatment demonstrated good agreement between planned and delivered dose.ConclusionsPalliative radiotherapy with IG-IMRT using an integrated imaging-planning-treatment delivery system is efficient and convenient for patients, and compares very favorably with conventional approaches. This is one of the first such reported series of rapid one-session IG-IMRT and it has great potential for future applications, including single-fraction radiotherapy. Purpose/Objective(s)To evaluate the feasibility of using an integrated imaging, planning, and treatment delivery system to deliver IG-IMRT for patients requiring urgent palliative radiotherapy (PRT). To evaluate the feasibility of using an integrated imaging, planning, and treatment delivery system to deliver IG-IMRT for patients requiring urgent palliative radiotherapy (PRT). Materials/MethodsBetween December 2006 and February 2008, 23 patients requiring urgent PRT were selected to undergo single-session MV-CT simulation, IMRT treatment planning, and delivery of the first fraction of radiotherapy on a helical Tomotherapy unit. The time required to complete each step was recorded along with the overall time spent in the treatment room. This was compared to the time required for our standard approach for PRT with either fluoroscopic or CT-based simulation, simple treatment planning, and treatment on a megavoltage machine (Cobalt-60 unit or 6 MV linac). The IMRT distributions were compared with the more conventional treatments plans that would normally be used. Between December 2006 and February 2008, 23 patients requiring urgent PRT were selected to undergo single-session MV-CT simulation, IMRT treatment planning, and delivery of the first fraction of radiotherapy on a helical Tomotherapy unit. The time required to complete each step was recorded along with the overall time spent in the treatment room. This was compared to the time required for our standard approach for PRT with either fluoroscopic or CT-based simulation, simple treatment planning, and treatment on a megavoltage machine (Cobalt-60 unit or 6 MV linac). The IMRT distributions were compared with the more conventional treatments plans that would normally be used. ResultsTwenty-three patients were treated with our integrated IG-IMRT protocol. The median age was 72 years, with 61% men and 39% women. The indications for PRT were as follows: 66% for painful bone metastases, 17% for bleeding, and 17% for other reasons. The average time required for the various processes was as follows: 15 minutes for MV-CT acquisition, 16 minutes for target volume delineation, 9 minutes for IMRT planning, 10 minutes for the repeat verification MV-CT, and 12 minutes for delivery of the first radiotherapy fraction. The average total time spent in the treatment room by patients was 62 minutes, and this decreased during the course of the study from over 90 minutes initially to approximately 60 minutes. The average time for our standard approach for simulation and immediate treatment for patients requiring urgent PRT with either fluoroscopy or conventional CT-simulation was 59 minutes and 92 minutes, respectively, and this excludes the time required to transfer patients between rooms and the waiting time between simulation and treatment. The IMRT dose distributions were more conformal than with the conventional approaches; with a more homogeneous dose to the target volume and a marked reduction in hotspots. This protocol was used for patients requiring single-fraction (8 patients) and short-course (15 patients receiving 2-5 fractions) PRT. The delivery quality assurance (DQA) done following the first fraction of treatment demonstrated good agreement between planned and delivered dose. Twenty-three patients were treated with our integrated IG-IMRT protocol. The median age was 72 years, with 61% men and 39% women. The indications for PRT were as follows: 66% for painful bone metastases, 17% for bleeding, and 17% for other reasons. The average time required for the various processes was as follows: 15 minutes for MV-CT acquisition, 16 minutes for target volume delineation, 9 minutes for IMRT planning, 10 minutes for the repeat verification MV-CT, and 12 minutes for delivery of the first radiotherapy fraction. The average total time spent in the treatment room by patients was 62 minutes, and this decreased during the course of the study from over 90 minutes initially to approximately 60 minutes. The average time for our standard approach for simulation and immediate treatment for patients requiring urgent PRT with either fluoroscopy or conventional CT-simulation was 59 minutes and 92 minutes, respectively, and this excludes the time required to transfer patients between rooms and the waiting time between simulation and treatment. The IMRT dose distributions were more conformal than with the conventional approaches; with a more homogeneous dose to the target volume and a marked reduction in hotspots. This protocol was used for patients requiring single-fraction (8 patients) and short-course (15 patients receiving 2-5 fractions) PRT. The delivery quality assurance (DQA) done following the first fraction of treatment demonstrated good agreement between planned and delivered dose. ConclusionsPalliative radiotherapy with IG-IMRT using an integrated imaging-planning-treatment delivery system is efficient and convenient for patients, and compares very favorably with conventional approaches. This is one of the first such reported series of rapid one-session IG-IMRT and it has great potential for future applications, including single-fraction radiotherapy. Palliative radiotherapy with IG-IMRT using an integrated imaging-planning-treatment delivery system is efficient and convenient for patients, and compares very favorably with conventional approaches. This is one of the first such reported series of rapid one-session IG-IMRT and it has great potential for future applications, including single-fraction radiotherapy.