Real-World Implementation of Simulation-Free Radiation Therapy (SFRT-1000): A Propensity Score-Matched Analysis of 1000 Consecutive Palliative Courses Delivered in Routine Care

Thilo Schuler; Stephanie Roderick; Shelley Wong; Alannah Kejda; Kylie Grimberg; Toby Lowe; John Kipritidis; Michael Back; Sarah Bergamin; Susan Carroll; George Hruby; Dasantha Jayamanne; Andrew Kneebone; Gillian Lamoury; Marita Morgia; Mark Stevens; Chris Brown; Blanca Gallego; Brian Porter; Jeremy Booth; Thomas Eade

doi:10.1016/j.ijrobp.2024.09.041

Real-World Implementation of Simulation-Free Radiation Therapy (SFRT-1000): A Propensity Score-Matched Analysis of 1000 Consecutive Palliative Courses Delivered in Routine Care

Int J Radiat Oncol Biol Phys. 2024 Sep 29:S0360-3016(24)03413-8. doi: 10.1016/j.ijrobp.2024.09.041. Online ahead of print.

Authors

Thilo Schuler¹, Stephanie Roderick², Shelley Wong², Alannah Kejda², Kylie Grimberg², Toby Lowe², John Kipritidis³, Michael Back⁴, Sarah Bergamin⁴, Susan Carroll⁴, George Hruby⁴, Dasantha Jayamanne⁴, Andrew Kneebone⁴, Gillian Lamoury⁴, Marita Morgia², Mark Stevens², Chris Brown⁵, Blanca Gallego⁶, Brian Porter², Jeremy Booth³, Thomas Eade⁴

Affiliations

¹ 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. Electronic address: [email protected].
² Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.
³ Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
⁵ NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
⁶ Centre for Big Data Research in Health, University of New South Wales, Sydney New South Wales, Australia.

PMID: 39353478
DOI: 10.1016/j.ijrobp.2024.09.041

Abstract

Purpose: The feasibility of simulation-free radiation therapy (SFRT) has been demonstrated but information regarding its routine care impact and scalability is lacking.

Methods and materials: 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.