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Published on: March 24, 2022
All-in-One Radiation Therapy for Oncologic Emergencies Using an Integrated Computed Tomography-Linac System: A
Haibo Peng1, Ningyue Xu2, Haohong Wu3
1Department of Oncology, School of Clinical Medicine and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China; Radiology and Therapy Clinical Medical Research Center of Sichuan Province, Chengdu, China.
Purpose:
The purpose of the study was to evaluate the workflow efficiency, dosimetric accuracy, and clinical outcomes of an all-in-one (AIO) radiation therapy workflow for oncologic emergencies using an integrated computed tomography-linear accelerator system.
Methods And Materials:
This retrospective study included 155 patients (January 2022-December 2025). A template-based AIO protocol was preestablished from conventional planning. Evaluation covered dosimetry, efficiency, and clinical response.
Results:
All 155 patients received AIO radiation therapy as the first treatment. The median prescription target coverage was 95.00% (range, 83.98%-99.98%); 95.48% met clinical goals. Median organ-at-risk sparing compliance was 100%. The median 2-dimensional in vivo gamma passing rate (GPR) (3%/3 mm) was 97.35% (IQR, 95.20%-98.96%); offline 3-dimensional reconstructed GPR (0.01% uncertainty) was 92.26% (IQR, 90.88%-93.80%). The phantom-based GPR (3%/2 mm) was 100% (IQR, 99.87%-100%). The median total workflow time was 24.66 minutes (IQR, 20.49-31.52 minutes). Acute symptom relief occurred in 89.68% of patients. The median Eastern Cooperative Oncology Group performance status improved from 2 to 1 (P = .001). In patients with superior vena cava syndrome, the median respiratory rate decreased from 24.5 to 20 breaths/min (P = .001). The median Numeric Rating Scale pain score decreased from 3 to 1 (P < .001). Among bleeding patients, 86.67% had reduced bleeding, and 53.33% achieved complete hemostasis. Three-month local control was 96.77%, with mild radiation therapy-related toxicity; median overall survival was 5.37 months (95% CI, 4.28-7.01 months). Cumulative survival rates at 3, 6, 12, and 24 months were 63.70%, 45.20%, 29.40%, and 25.10%, respectively.
Conclusions:
The template-based AIO radiation therapy workflow enables rapid admission-to-treatment, delivering clinically acceptable plans with high accuracy. It allows rapid relief of acute symptoms and widens the window for subsequent therapy.
