The Emerging Role of IG-IMRT for Palliative Radiotherapy: A Single-Institution Experience

Abstract

minimize side effects, and can be planned relatively quickly. Delaying the start of radiotherapy because of a complicated treatment planning process does not make sense. For patients requiring palliative radiotherapy, specialized clinics have even been developed where treatment (with one or a few fractions of radiotherapy) is planned and administered on the same day that the consultation takes place 15 . Usually, fluoroscopic simulation and simple treatment approaches such as direct fields or parallel opposed fields are used in these clinics. However, are we utilizing the available radiotherapy scanning, planning, and treatment tools to the fullest extent possible in the palliative setting?We believe that, in certain situations, it is possible to use state-of-the-art ig-imrt approaches to deliver palliative radiotherapy in a safe, efficient, and effective manner without excessive wait times. It seems intuitive that, if radiotherapy could be focused more precisely, then it could be more effective and should lead to fewer side effects, because the tumour can be targeted more accurately and normal structures can be avoided. In the palliative setting, in which the goal tends to be delivery of low-to-moderate doses of radiation with minimal toxicity 13 , an ig-imrt approach would seem to be most appropriate. Here, we review our experience using ig-imrt on our helical TomoTherapy unit (TomoTherapy Incorporated, Madison, WI, U.S.A.) in the palliative setting. PATIENTS AND METHODSIn the spring of 2005, the Ottawa Hospital Cancer Centre installed a helical TomoTherapy unit (htu), and after a commissioning process that took 2 weeks, it started treating patients in September 2005. The htu was acquired mainly for research purposes, and many of the patients were on study protocols. However, having quickly realized the value and versatility of an ig-imrt approach, we began using it for selected palliative situations in which standard approaches might not be safe, and for unique situations in which palliative radiotherapy, although effective, would be difficult to administer. We subsequently created a protocol for scanning, planning, and treating ABSTRACTMany modern radiotherapy centers now have imageguided intensity-modulated radiotherapy (ig-imrt) tools available for clinical use, and the technique offers many options for patients requiring palliative radiotherapy. We describe a single-institution experience with ig-imrt for short-course palliative radiotherapy, highlighting the unique situations in which the technique can be most effectively used.

Barriers to palliative radiotherapy referral: A Canadian perspective

“…Studies from several European countries, including Sweden, with similar health care systems and availability of resources have also identified problems related to radiotherapy referral [9,12,13,18]. It has long been felt that the proximity to cancer centres, perceived patient inconvenience, and waiting times for consultation and treatment are concerns for referring doctors, and these were confirmed in our survey [6,7,10,11,19]. However, we found that other factors also have a major influence on referral.…”

Rapid Access Palliative Radiation Therapy Programs: An Efficient Model of Care

“…This sophisticated level of RT delivery would be ideal for cases often seen within these clinics when targets assume challenging geometric configurations, when they approach sensitive structures (often in the reirradiation setting), or when they could benefit from dose escalation over conventional doses [40,41]. This sophisticated level of RT delivery would be ideal for cases often seen within these clinics when targets assume challenging geometric configurations, when they approach sensitive structures (often in the reirradiation setting), or when they could benefit from dose escalation over conventional doses [40,41].…”

Variation in the use of palliative radiotherapy at end of life: Examining demographic, clinical, health service, and geographic factors in a population-based study

“…3,4 Radiotherapy (RT) is cost-effective compared with other available palliative treatments, [5][6][7][8] and is inversely correlated with hospital bed use at end of life. 9 PRT is one form of palliative medicine that has the potential to improve quality of life for patients with advanced cancer.…”