Rapid Response Palliative Radiation Therapy Program: Feasibility and Experience of Implementing a Nonclassical Model

Classical rapid access palliative radiation therapy (RAPRT) programs are typically organized as dedicated clinics designed to enable same-day consultation, simulation, treatment planning, and delivery of palliative radiation therapy. At our institution, urgent and expedited palliative radiation therapy is delivered through an integrated, nonclassical RAPRT model embedded in routine departmental practice. This study describes the implementation and performance of this model.

We retrospectively reviewed patients treated by our RAPRT workflow between January 1, 2018, and December 31, 2024. Demographic, clinical, treatment-related, and workflow data were collected from the institutional oncology information system and clinical records. Workflow intervals were calculated using electronic timestamps.

A total of 775 patients received 848 treatment courses; 37% were hospitalized at the time of treatment. Fifty-six patients (7.2%) received >1 treatment course, and 15 required reirradiation. The median time from referral to radiation oncology consultation was 1 day (Q1, 1; Q3, 3). Median age was 63 years (Q1, 54; Q3, 73), and the most common primary tumors were lung (25%) and gastrointestinal cancers (17%). Poor performance status (Eastern Cooperative Oncology Group performance status 3-4) was observed in 40% of cases. The most common treatment sites were bone (47%) and thorax (19%). A single fraction was prescribed in 797 extracranial courses, representing 94% of all courses. Median total treatment process time was 109 minutes (Q1, 102; Q3, 165), and median time spent in the radiation therapy center was 207 minutes (Q1, 111; Q3, 250). Time to simulation and dosimetry time were the most time-consuming workflow steps, accounting for 24% and 31% of the total workflow duration, respectively.

An integrated, nonclassical RAPRT model using existing departmental resources is feasible and can achieve rapid palliative radiation therapy timelines comparable to those reported by dedicated RAPRT programs. Robust information systems and coordinated electronic workflows are central to the efficient implementation of this model.