Packed schedules.

Top Line: While there may be few radiation oncology emergencies, there are urgent symptoms that are ideally treated sooner rather  than later.

The Study: The part of the algorithm that can most often hang things up, particularly at busy centers with full schedules, is the CT simulation. Fortunately, these scenarios often call for relatively simple palliative radiation techniques. Enter the simulation-free treatment. Here’s a detailed report of Wash U’s experience using this algorithm for 30 patients throughout 2020. All patients had recent diagnostic CT scans (could be from PET-CT) that encompassed the treatment field without any intervening major anatomic changes (e.g., thora- or paracentesis). These scans were simply downloaded to the treatment planning software and things progressed as usual from there. Now again, these are not sophisticated plans, typically meaning your only constraint is a hotspot <110% and you accept that everything in the field will receive prescription dose. When compared to a matched cohort of 30 patients receiving palliative radiation with standard CT simulation, time from consult to plan generation was halved from 1.9 → 0.9 days. Interestingly, planned doses were compared to delivered doses for the 30 sim-free patients by evaluating on-treatment cone beam CT anatomy. Mean deviation of Dmax was 0.07% and maximum deviation was 4.1%.

TBL: If packed sim schedules are putting a kink in your expedited palliative radiation delivery, try a sim-free treatment. | Schiff, Adv Radiat Oncol 2022