Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-13T07:16:04.522Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hoegler, D. Radiotherapy for palliation of symptoms in incurable cancer. Curr Probl Cancer 1997; 21: 129–183.CrossRefGoogle ScholarPubMed
2.Stevens, G, Firth, I. Clinical audit in radiation oncology: results from one centre. Australas Radiol 1996; 40: 47–54.Google ScholarPubMed
3.Williams, MV, James, ND, Summers, ET, Barrett, A, Ash, DV. Audit Sub-Committe, Faculty of Clinical Oncology; Royal College of Radiologists. National survey of radiotherapy fractionation practice in 2003. Clin Oncol (R Coll Radiol) 2006; 18: 3–14.CrossRefGoogle ScholarPubMed
4.Konski, A, Feigenberg, S, Chow, E. Palliative radiation therapy. Semin Oncol 2005; 32: 156–164.CrossRefGoogle ScholarPubMed
5.Purdy, JA. From new frontiers to new standards of practice: advances in radiotherapy planning and delivery. Front Radiat Ther Oncol 2007; 40: 18–39.CrossRefGoogle ScholarPubMed
6.Smith, RP, Heron, DE, Huq, MS, Yue, NJ. Modern radiation treatment planning and delivery–from Röntgen to real time. Hematol Oncol Clin North Am 2006; 20: 45–62.CrossRefGoogle ScholarPubMed
7.Nijkamp, J, Pos, FJ, Nuver, TT, de Jong, R, Remeijer, P, Sonke, JJ, Lebesque, JV. Adaptive radiotherapy for prostate cancer using kilovoltage cone-beam computed tomography: first clinical results. Int J Radiat Oncol Biol Phys 2008; 70: 75–82.CrossRefGoogle ScholarPubMed
8.Woodford, C, Yartsev, S, Dar, AR, Bauman, G, Van Dyk, J. Adaptive radiotherapy planning on decreasing gross tumor volumes as seen on megavoltage computed tomography images. Int J Radiat Oncol Biol Phys 2007; 69: 1316–1322.CrossRefGoogle ScholarPubMed
9.Elshaikh, M, Ljungman, M, Ten Haken, R, Lichter, AS. Advances in radiation oncology. Annu Rev Med 2006; 57: 19–31.CrossRefGoogle ScholarPubMed
10.James, HV, Scrase, CD, Poynter, AJ. Practical experience with intensity-modulated radiotherapy. Br J Radiol 2004; 77: 3–14.CrossRefGoogle ScholarPubMed
11.Samant, R, Gerig, L, Montgomery, L, Macrae, R, Fox, G, Nyiri, B, Carty, K, Macpherson, M. The emerging role of IG-IMRT for palliative radiotherapy: a single-institution experience. Curr Oncol 2009; 16: 40–45.CrossRefGoogle ScholarPubMed
12.Baisden, JM, Benedict, SH, Sheng, K, Read, PW, Larner, JM. Helical TomoTherapy in the treatment of central nervous system metastasis. Neurosurg Focus 2007; 22:E8.CrossRefGoogle ScholarPubMed
13.Hein, PA, Gladstone, DJ, Bellerive, MR, Hug, EB. Importance of protocol target definition on the ability to spare normal tissue: an IMRT and 3D-CRT planning comparison for intraorbital tumors. Int J Radiat Oncol Biol Phys 2005; 62: 1540–1548.CrossRefGoogle ScholarPubMed
14.Lee, IJ, Seong, J, Lee, CG, Kim, YB, Keum, KC, Suh, CO, Kim, GE, Cho, J. Early clinical experience and outcome of helical tomotherapy for multiple metastatic lesions. Int J Radiat Oncol Biol Phys 2009; 73: 1517–1524.CrossRefGoogle ScholarPubMed
15.Wright, JL, Lovelock, DM, Bilsky, MH, Toner, S, Zatcky, J, Yamada, Y. Clinical outcomes after reirradiation of paraspinal tumors. Am J Clin Oncol 2006; 29: 495–502.CrossRefGoogle ScholarPubMed
16.MacPherson, M, Montgomery, L, Fox, G, Carty, K, Gerig, L, MacRae, R, Grimard, L, Clark, BG, Samant, R. On-line rapid palliation using helical tomotherapy: a prospective feasibility study. Radiother Oncol 2008; 87: 116–118.CrossRefGoogle ScholarPubMed
17.Driver, DM, Drzymala, M, Dobbs, HJ, Faulkner, S, Harris, S. Virtual simulation in palliative lung radiotherapy. Clin Oncol (R Coll Radiol) 2004; 16: 461–466.CrossRefGoogle ScholarPubMed
18.Haddad, P, Cheung, F, Pond, G, Easton, D, Cops, F, Bezjak, A, McLean, M, Levin, W, Billingsley, S, Williams, D, Wong, R. Computerized tomographic simulation compared with clinical mark-up in palliative radiotherapy: a prospective study. Int J Radiat Oncol Biol Phys 2006; 65: 824–829.CrossRefGoogle ScholarPubMed
19.McJury, M, Fisher, PM, Pledge, S, Brown, G, Anthony, C, Hatton, MQ, Conway, J, Robinson, MH. The impact of virtual simulation in palliative radiotherapy for non-small-cell lung cancer. Radiother Oncol 2001; 59: 311–318.CrossRefGoogle ScholarPubMed
20.Lorenz, KA, Lynn, J, Dy, SM, Shugarman, LR, Wilkinson, A, Mularski, RA, Morton, SC, Hughes, RG, Hilton, LK, Maglione, M, Rhodes, SL, Rolon, C, Sun, VC, Shekelle, PG. Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med 2008; 148: 147–159.CrossRefGoogle ScholarPubMed
21.Danjoux, C, Chow, E, Drossos, A, Holden, L, Hayter, C, Tsao, M, Barnes, T, Sinclair, E, Farhadian, M. An innovative rapid response radiotherapy program to reduce waiting time for palliative radiotherapy. Support Care Cancer 2006; 14: 38–43.CrossRefGoogle ScholarPubMed