O'Neil on the Feasibility of Diagnostic CT-Enabled Planning For Patients Receiving Palliative Radiation Therapy

Melissa O'Neil, MRT(T), advanced practice radiation therapist, the Department of Radiation Oncology, leader, Rapid Response Clinic, London Regional Cancer Program, Ontario, Canada, discusses findings from the randomized phase 2 Diagnostic CT-Enabled Radiation Therapy (DART) trial (NCT05233904) in patients treated with palliative radiation therapy (PRT).

The DART study assessed the effectiveness, acceptability, and scalability of diagnostic CT (dCT)-enabled planning compared with traditional computerized tomography (CT) simulation planning for patients undergoing PRT of the bone, soft tissue, and lung, with a specific investigation into the feasibility of a sim-free PRT pathway. By improving patient experience, plan deliverability, adequacy of target coverage, and staff workflows, dCT scans is hypothesized to increase departmental efficiency and reduce patient burden.

This study enrolled 33 patients undergoing PRT across 42 treatment sites, and randomly assigned them in a 1:2 ratio between conventional CT simulation (Arm 1), and the diagnostic CT enabled planning workflow (Arm 2). Patients were then stratified by treatment target volume. Notably, the most prescribed dose of radiation therapy were 8 Gy in 1 fraction and 20 Gy in 5 fractions.

The investigation resulted in a significant reuduction in the time interval from dCT to enrollment compared with the control arm when utilizing dCT scans for radiation planning, O’Neil reports. Moreover, patients in the dCT cohort spent significantly less time at the cancer center, meeting the study's primary end point, she states.

Further analysis of secondary end point revealed that all radiation plans in the dCT arm were deliverable and maintained acceptable dose distribution rates, O’Neil continues. Patients in the dCT arm also reported a significantly lower time burden compared with the control arm, she adds. Importantly, 90% of clinical stakeholders, including radiation oncologists and medical physicists, rated the dCT workflow as a 4 or higher on a 5-point scale ranging from unacceptable (1) to acceptable (5), O’Neil emphasizes. Patient perception of acceptability was similar between both arms except for time burden, which was rated as “acceptable” by more patients in the dCT arm vs the CT simulation arm, she details.

Overall, dCT-based radiation planning was determined to be a feasible and efficient approach, offering reduced time burden for patients undergoing PRT without compromising plan deliverability or quality, O’Neil concludes.