Author: William Amestoy, Carolina Benjamin, Markus Bredel, Rodrigo Delgadillo, Nesrin Dogan, Michael E Ivan, Ricardo J Komotar, Gregory J. Kubicek, Eric Mellon, Ivaylo B. Mihaylov, Maria Irene Monterroso, Raymond A. Schulz, Ashish Shah, Robert M Starke 👨🔬
Affiliation: University of Miami, Department of Radiation Oncology, University of Miami, University of Miami Sylvester Comprehensive Cancer Center, Varian Medical Systems 🌍
Purpose: Stereotactic Radiosurgery (SRS) is a widely used treatment modality in radiation oncology, utilizing various technologies such as Gamma Knife (GK), Cyber Knife (CK) and Linac-based SRS with Hyper-Arc (HA). One advantage of GK is its logistical efficiency, as patients can undergo imaging, planning and treatment on the same day. To create parity between GK and HA, a streamlined workflow that facilitates same-day HA treatment while minimizing disruption to departmental operations, was developed.
Methods: Patient selection for same-day HA treatment includes those with benign conditions or brain metastases, with five or fewer targets. Departmental resources for this process include a dedicated SRS physicist for the day and reserved MRI and CT slots in the morning for imaging. The workflow begins with the MRI, and if it reveals significant deviations from the expected results, the same-day HA is canceled. CT simulation follows the MRI. Image fusion and planning contours must be completed by 11 AM, to allow adequate time for planning and quality assurance (QA). Treatment is delivered after plan is reviewed by physician and physicist, and QA approval.
Results: It was found that a same-day HA workflow enables the offer of this treatment to selected patients, without placing excessive strain on departmental resources. The median time from simulation to treatment delivery is 5.8 hours, with a range of 3.5 to 9.3 hours.
Conclusion: Same-day HA is not only feasible but also offers a logistical advantage for select patients. This work provides policy recommendations for integrating same-day HA into an existing SRS program.