ESTRO 2024 - Abstract Book

S123

Invited Speaker

ESTRO 2024

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For similar cosmetic, functional and cosmetic issues, such an approach through interventional radiotherapy may be useful in other, even more common situations, as SCC of the buccal mucosa. We present some clinical cases.

3539

The use of MRI-guided palliative radiotherapy for metastatic spinal cord compression

Cynthia L Eccles

The Christie NHS FT, Radiotherapy, Manchester, United Kingdom. The University of Manchester, Cancer Sciences, Manchester, United Kingdom

Abstract:

Malignant spinal cord compression (MSCC) is a cancer emergency that affects 1 in 10 cancer patients. Most MSCC patients are receiving end of life care with limited life expectancy. Rapid symptom relief is critical in this vulnerable population. Radiotherapy is an essential part of treating symptoms like pain and stopping nerve damage from MSCC, that impacts on mobility, continence and quality-of-life. MSCC patients often endure long waits from time of intent to treat to radiotherapy. There can be numerous appointments involving multiple healthcare professionals before treatment starts. Currently, there are two approaches to reduce waiting times. First, having a dedicated team, including a specialist radiographer who in the UK acts as a primary point of contact, to co-ordinate appointments and tasks required from consultation to treatment completion. In the Canadian model, this radiographer also leads in the patient consultation and decision to treat, performs the treatment imaging and planning, and prescribes pain medications as required. Second, waiting times are reduced by using specialist equipment to eliminate the need for pre- treatment computerised tomography (CT) appointment required to plan (design) radiotherapy. By using specialised equipment, this planning CT can be taken on the treatment delivery machine. The specialised system includes an integrated planning computer to plan the treatment, immediately before delivering radiotherapy. This approach has not been widely adopted due to the limited availability of specialised equipment. There is now potential for a third approach. The magnetic resonance (MRI) linear accelerator (MRL) combines an MRI machine with radiotherapy treatment machine and a radiotherapy planning computer that can design the treatment immediately before delivering the treatment. This approach allows for the use of existing diagnostic sans to be used for the creation of a reference plan, which can be adapted using a on on-treatment MRI immediately before treatment delivery. The approach would eliminate the need for a planning CT, alongside a new diagnostic MRI, reducing the number of hospital appointments required from three to one. We propose that the combination of the unique properties of the MR-Linac with a dedicated palliative care radiographer to implement a rapid response MRI-guided palliative radiotherapy programme of care for patients with MSCC will:

• Reduce overall time from consultation to treatment from an average of 3 days to <24 hours

• Reduce the number of appointments/procedures required