Virtual simulation-based planning reduced the time from initial consultation to treatment start by more than half for patients awaiting urgent palliative radiation therapy for painful bone metastases, researchers reported in Advances in Radiation Oncology.

“Rapid pain relief for patients with bone metastases can be a challenge due to the lengthy and complex radiation therapy workflow,” Aaron Bush, MD, and colleagues wrote. “The purpose of this study was to evaluate the time (in days) between initial radiation oncology consultation and start of palliative radiation treatment after implementing an alternative virtual simulation palliative workflow.”

The approach used a pre-existing diagnostic CT scan that visualizes the target volume for treatment planning instead of a standard, in-person CT simulation scan. Patients chosen for virtual simulation had painful bone metastases and were recommended for palliative radiation therapy with standard anterior-posterior/posterior-anterior or opposed lateral fields. The study also required a recent diagnostic CT scan within 30 days, clearly visualizing the target volume for treatment planning.

Virtual Planning Offers Benefit for Underserved Groups

The virtual simulation program included 23 patients who lived locally (<50 miles from the treatment center) and 22 patients who were considered distant (≥50 miles from the treatment center).

The average time from consultation to treatment was 3.7 days for 45 patients who received virtual simulation planning compared with 7.5 days for 40 patients who underwent traditional CT simulation (3.8 days sooner, on average; P≤0.001).  The benefit of virtual simulation planning was most significant for outpatients traveling 50 miles or more for treatment.

For virtual simulation-based plans, the average V90, V95, and V99 were 99.99%, 99.87%, and 96.70%, respectively.  The researchers reported no significant difference in planning target volume coverage was found on subsequent in-person CT simulation scans.

“The virtual simulation program decreased the time from consultation to start of treatment by more than 50% for patients recommended palliative radiation therapy for painful bone metastases,” Dr. Bush and colleagues wrote. “Virtual simulation-based planning can be considered for patients anxious to proceed with radiation therapy quickly or in underserved settings with limited transportation options to regional treatment ment centers.”