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O'Neil M, Laba JM, Nguyen TK, Lock M, Goodman CD, Huynh E, Snir J, Munro V, Alce J, Schrijver L, Lemay S, MacDonald T, Warner A, Palma DA. Diagnostic CT-Enabled Planning (DART): Results of a Randomized Trial in Palliative Radiation Therapy. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00396-1. [PMID: 38613562 DOI: 10.1016/j.ijrobp.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/12/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Using diagnostic computed tomography (dCT) scans instead of CT simulation (CTsim) scans can increase departmental efficiency and reduce patient burden. The goal of the DART trial was to assess the efficacy and acceptability of dCT-based planning workflows with a focus on patient experiences, plan deliverability and adequacy of target coverage, and workflows. METHODS AND MATERIALS Patients undergoing same-day CTsim and treatment for palliative radiation therapy to thoracic, abdominopelvic, or proximal limb targets with a recent dCT (within 28 days) in a reproducible position were eligible. After stratifying by target type (bone or soft tissue vs. visceral), participants were randomized (1:2 ratio) between CTsim-based (CTsim arm) vs. dCT-based planning (dCT arm). The primary endpoint was time in center (TIC), defined as total time spent in the cancer center on first day of treatment, from first radiation department appointment to first fraction completion. Secondary endpoints included plan deliverability, adequacy of target coverage, and stakeholder acceptability. RESULTS Thirty-three patients (42 treatment sites) were enrolled between June 2022 and April 2023. The median age was 72 (interquartile range [IQR]: 67-78), 73% were male, and the most common primary cancers were lung (33%), prostate (24%), and breast (12%). The most common dose and fractionations were 8 Gy in 1 and 20 Gy in 5 fractions (50% and 43% of plans, respectively). TIC was 4.7 ± 1.1 hours (mean ± SD) in the CTsim arm vs. 0.41 ± 0.14 hours in the dCT arm (P < .001). All dCT plans were deliverable. All plans in both arms were rated as "acceptable" (80% CTsim; 81% dCT) or "acceptable with minor deviation" (20% CTsim; 19% dCT). Patient perception of acceptability was similar in both arms with the exception of time burden, which was rated as "acceptable" by 50% in the CTsim arm vs. 90% in the dCT arm (P = .025). CONCLUSION dCT-based radiation planning substantially reduced TIC without detriment in plan deliverability or quality and had a tangible impact on patient experience with reduced patient-reported time burden.
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Affiliation(s)
- Melissa O'Neil
- Department of Radiation Therapy, London Health Sciences Centre, London, Ontario, Canada
| | - Joanna M Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Timothy K Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Michael Lock
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Christopher D Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Elizabeth Huynh
- Department of Medical Biophysics, London Health Sciences Centre, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Jonatan Snir
- Department of Medical Biophysics, London Health Sciences Centre, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Vikki Munro
- Department of Radiation Therapy, London Health Sciences Centre, London, Ontario, Canada
| | - Jenna Alce
- Department of Radiation Therapy, London Health Sciences Centre, London, Ontario, Canada
| | - Lidia Schrijver
- Department of Radiation Therapy, London Health Sciences Centre, London, Ontario, Canada
| | - Sylvia Lemay
- Department of Radiation Therapy, London Health Sciences Centre, London, Ontario, Canada
| | - Tara MacDonald
- Department of Radiation Therapy, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada.
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