3538 - Rapid Response Palliative Radiotherapy Program (RAPRT): Experience with a Non-Classical Model

Purpose/Objective(s): A "classical" RAPRT clinic is defined as a dedicated clinic established to enable same-day consultation, planning, and delivery of palliative radiation treatment. At our center, RAPRT does not follow this classical model. Instead, at our institution, all radiation oncologists (ROs) treat patients with symptoms of advanced cancer as part of their routine daily practice. This study aims to describe our experience implementing a non-classical RAPRT model.

Materials/Methods: Using a patient information system, we retrospectively reviewed data from patients treated at our institution between January 1, 2018, and June 30, 2024. Administrative data (referral dates), demographic and clinical information, and time intervals within the treatment workflow were collected.

Results: A total of 610 patients (50.3% male) received 709 treatment courses, with 38% referred for treatment while hospitalized at other institutions. Forty-seven patients (7.7%) underwent multiple treatment courses, and 15 required reirradiation. The median age was 63 years [Q₁ 53, Q₃ 73], with lung (23.7%) and gastrointestinal (17.6%) cancers being the most common primary tumors. Poor performance status (ECOG 3–4) was observed in 57% of cases, and the most frequent treatment indications were bone (48%) and thoracic (19%) symptoms. Whole-brain radiotherapy (WBRT) was performed in 2.3% of cases, all receiving 20 Gy in 5 fractions with 3DCRT. A single-fraction regimen was prescribed in 94% of non-encephalic treatments, all of which were planned with IMRT. The median treatment process time was 124 minutes [Q₁ 84, Q₃ 146] and median time spent at radiotherapy center was 195 minutes [Q₁ 148, Q₃ 245]. Table 1 presents the time spent at each stage of the treatment workflow. Time-to-simulation and dosimetry were the most time-consuming processes, accounting for 22% and 27% of the total workflow duration, respectively. The median overall survival was 107 days [Q₁ 40, Q₃ 269].

Conclusion: A non-classical RAPRT model is a feasible approach to improving access to palliative radiotherapy, particularly for patients with poor performance status and limited survival. High-quality information systems and optimized workflows are essential to achieving a coordinated and time-efficient RAPRT using existing resources.