3717 - Progressive Institutional Standardization of VMAT for Palliative Radiotherapy in a Low- and Middle-Income Country: A 5-Year Time-Series Analysis
Presenter(s)
B. Souza1, M. C. Rosa2, L. Martins2, L. Pedro1, L. D. Faroni3, and F. Y. Y. Moraes4; 1Oncologia D'Or, Rio de Janeiro, Brazil, 2Oncologia D’Or, Rio de Janeiro, Brazil, 3D'Or Oncology Center, Rio de Janeiro, Brazil, 4Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): Adoption of advanced radiotherapy technologies in low- and middle-income countries (LMICs) remains heterogeneous, particularly in palliative care where simpler techniques are traditionally prioritized. We evaluated the institutional standardization and scale-up of volumetric modulated arc therapy (VMAT) for palliative radiotherapy and its impact on operational performance over time.
Materials/Methods: We conducted a retrospective institutional time-series analysis of all patients treated with palliative-intent radiotherapy from 2020–2025. Annual VMAT utilization proportions were calculated. Operational metrics included image-guided radiotherapy (IGRT) use, simulation-to-treatment interval, fractionation patterns, treatment site distribution, and annual case volume. Temporal trends were assessed descriptively to characterize implementation and workflow sustainability.
Results: A total of 1,882 patients received palliative radiotherapy during the study period. VMAT utilization was consistently high and progressively consolidated: 95% (2020), 85% (2021), 90% (2022), 93% (2023), 93% (2024), and 98% (2025). IGRT was used in 98% of treatments. The most frequent indications were bone metastases, central nervous system, and thoracic lesions. Despite increasing annual patient volumes and near-universal VMAT adoption, the mean interval from simulation to treatment initiation remained stable at 10 days throughout the period. The mean number of fractions per course was 4.8, consistent with hypofractionated palliative regimens. Treatments were delivered using two linear accelerators without evidence of workflow delay or fractionation prolongation over time
Conclusion: Institutional standardization of VMAT combined with routine IGRT enabled large-scale implementation of advanced radiotherapy in the palliative setting within an LMIC context without compromising treatment timeliness or hypofractionation practices. These findings provide operational evidence that modern radiotherapy technologies can be sustainably integrated into high-volume palliative care workflows in resource-constrained environments and may serve as a scalable model for technology adoption in similar settings.