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Rapid palliative radiotherapy: comparing IG-IMRT with more conventional approaches

Published online by Cambridge University Press:  15 September 2010

Rajiv Samant ,
Lee Gerig ,
Lynn Montgomery ,
Miller MacPherson ,
Greg Fox ,
Robert MacRae ,
Kathy Carty ,
Steve Andrusyk ,
Paul Genest  and
Balazs Nyiri
Rajiv Samant*
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre Faculty of Medicine, University of Ottawa
Lee Gerig
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre Department of Physics, Carleton University, Ottawa, Ontario, Canada
Lynn Montgomery
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre
Miller MacPherson
Affiliation:
Department of Medical Physics, Carlo Fidani Peel Regional Cancer Centre, Mississauga, Ontario, Canada Department of Radiation Medicine and Physics, The University of Toronto, Toronto, Ontario, Canada
Greg Fox
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre
Robert MacRae
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre Faculty of Medicine, University of Ottawa
Kathy Carty
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre
Steve Andrusyk
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre
Paul Genest
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre Faculty of Medicine, University of Ottawa
Balazs Nyiri
Affiliation:
Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre Department of Physics, Carleton University, Ottawa, Ontario, Canada
*
Correspondence to: Rajiv Samant, Radiation Oncologist, Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. Email: rsamant@ottawahospital.on.ca
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Abstract

Purpose: To assess the efficiency of an integrated imaging, planning, and treatment delivery system to provide image-guided intensity-modulated radiotherapy (IG-IMRT) for patients requiring palliative radiotherapy (PRT).

Methods: Between December 2006 and May 2008, 28 patients requiring urgent PRT were selected to undergo single-session megavoltage computed tomography (MV-CT) simulation, IMRT treatment planning, position verification and delivery of the first faction of radiotherapy on a helical Tomotherapy® unit. The time required to complete each step was recorded and compared to our standard approach of using either fluoroscopic or CT-based simulation, simplified treatment planning and delivery on a megavoltage unit.

Results: Twenty-eight 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: painful bone and soft tissue metastasis (75%); bleeding lesions (14%); and other reasons (11%). The areas treated included the following: hip and/or pelvis (42%); spine (36%); and other areas (21%). The most commonly used dose prescription was 20 Gy in five fractions. Average times for the integrated IG-IMRT processes were as follows: image acquisition, 15 minutes; target delineation, 16 minutes; IMRT treatment planning, 9 minutes; treatment position verification, 10 minutes; and treatment delivery, 12 minutes. The average total time was 62 minutes compared to 66 minutes and 81 minutes for fluoroscopic and CT-simulation-based approaches, respectively. The IMRT dose distributions were also superior to simpler plans.

Conclusions: PRT with an integrated IG-IMRT approach is efficient and convenient for patients, and has potential for future applications such as single-fraction radiotherapy.

Keywords

Palliative radiotherapyIG-IMRTintegrated imaging–planning–treatment
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 9 , Issue 3 , September 2010 , pp. 143 - 148
Copyright
Copyright © Cambridge University Press 2010

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