Palliative Care

PV QA 3 - Poster Viewing Q&A 3

TU_32_3059 - A Method to Reduce Time to Start for Patients Receiving Palliative Radiation Therapy for Painful Spine Metastases

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

A Method to Reduce Time to Start for Patients Receiving Palliative Radiation Therapy for Painful Spine Metastases
G. Glober1, T. W. Holmes2, B. Chauhan2, A. P. Shah2, T. Dvorak1, J. M. Rineer2, and P. Kelly2; 1University of Central Florida College of Medicine, Orlando, FL, 2Orlando Health - UF Health Cancer Center, Orlando, FL

Purpose/Objective(s): Radiation therapy is an effective palliative measure for patients suffering from painful bone metastases yielding pain relief in approximately 60 to 85% of cases. Current practice in most centers requires patients to undergo CT simulation followed by treatment planning in order to start palliative radiation therapy. The logistics of scheduling and performing CT simulation results in an extra visit for patients and prolongs patient suffering by delaying the start of therapy. The goal of this study is to determine whether previously-obtained diagnostic CT scans can be used for radiation therapy treatment planning for painful spine metastasis. If possible, this approach would obviate the need for CT simulation, reducing the burden on the patient and potentially the amount of time before a patient can begin treatment and realize the palliative benefits of therapy.

Materials/Methods: We randomly selected 10 patients treated for spine metastases with palliative radiation therapy in 2017 in our department. All patients had undergone CT simulation for treatment planning and all patients were treated with opposed fields. The patients’ medical records were reviewed and the most recent diagnostic CT scans of the patients that contained the region of interest was imported into the registration system and corrected for orientation and alignment. These scans were then imported into a treatment planning system and plans were designed to treat the affected spine to 30 Gy in 10 fractions. In order to determine the safety of this protocol, the treatment plans were then transferred without alteration onto the CT data set obtained at the time of CT simulation, and the dose distributions were compared.

Results: Each of the patients identified had a previous diagnostic CT scan within 50 days of their start of palliative radiation (Median 25; range 3-50). There were limited differences in the dose distributions in the plans generated on the diagnostic scans and dose distributions after transfer to the CT simulation data sets. The maximum point dose was within 4% (range -4% to 1%), and the volumes receiving 30 Gy and 27 Gy were within 8% (range, -5% to 7%) and 3% (range -3% to 2%) respectively. Additionally, the treatment plans after transfer to the CT simulation data sets were each reviewed by two physicians in the department not involved in the replanning portion of the study, and 100% of the plans were felt to be appropriate for treatment.

Conclusion: This study demonstrates that diagnostic imaging scans can reasonably be used to plan many patients requiring palliative radiation for spine metastases. This approach has the potential to reduce the time to treatment start for patients receiving palliative radiation allowing them to experience pain relief earlier and improving patient quality of life.

Author Disclosure: G. Glober: None. T.W. Holmes: None. B. Chauhan: None. P. Kelly: None.

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