126 - Real-world implementation of simulation-free radiotherapy (SFRT-1000): A propensity score-matched analysis of 1000 consecutive palliative courses delivered in routine care

T. Schuler^1,2, S. Roderick¹, S. Wong¹, A. Kejda¹, K. Grimberg¹, T. Lowe¹, J. Kipritidis¹, M. Back^1,3, S. Bergamin^1,3, G. Hruby^1,3, A. Kneebone^1,3, S. Carroll^1,3, D. Jayamanne^1,3, G. M. Lamoury^1,3, M. Morgia¹, M. Stevens¹, C. Brown⁴, J. Booth^1,5, B. Porter¹, and T. N. Eade^1,3; ¹Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia, ²Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia, ³Sydney Medical School, University of Sydney, Sydney, NSW, Australia, ⁴NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia, ⁵Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia

Purpose/Objective(s): The feasibility of simulation-free radiotherapy (SFRT) has been demonstrated but information regarding its impact on routine care is lacking. The hypothesis was that SFRT is scalable and beneficial in routine care. Key endpoints of this single institution study were SFRT utilization, impact on consultation-to-RT time and on-couch treatment duration. Materials/

Methods: All patients receiving palliative RT in the study period were eligible for consideration of SFRT unless mask immobilization, a stereotactic technique, or a definitive dose was required. Timing metrics were compared to a contemporary local cohort that received simulation-based palliative RT using unadjusted medians (Wilcoxon rank-sum test) and a propensity score-matched regression. Electronic patient-reported outcomes (ePROs) captured 2-week toxicity and pain response.
Results: Between April 2018 and February 2024, 2849 palliative radiation courses were delivered, of which 1904 were eligible for this study. 1000 of the 1904 courses (52.5% SFRT utilization) were treated using the SFRT protocol, including 668 with IMRT/VMAT. Median patient age was 71 years with 60% being male and 42% being ECOG 2-4. SFRT reduced median consultation-to-RT time from 7.0 to 5.1 days (p<0.0001) corresponding to an adjusted average treatment effect in the treated (aATT) of -2.1 days (95%CI -2.8 to -1.3). SFRT increased median on-couch treatment duration from 17.8min to 20.5min (p<0.0001; aATT 2.6min, 95%CI 1.3 to 3.9). SFRT utilization in eligible courses increased from 41% to 54% between years 2018-19 and 2022-24. PRO-CTCAE grade 3 acute toxicity was 9% and at 4 weeks post RT patients with moderate/severe pain at baseline (= 5/10) had had a mean pain reduction of 3.5 points (7.1 to 3.6).
Conclusion: Using widely available technologies the SFRT-1000 cohort demonstrates routine care scalability with patient-centered and workflow benefits. SFRT is an attractive new palliative RT paradigm implementable in most settings.