Multiple Treatment Centre Dedicated Stereotactic Radiotherapy Team: Does It Work?

Abstract

Stereotactic radiotherapy delivery relies on not only the latest technology, equipment and processes, but also a high level of experience, skill, and human resources. This can present some challenges when delivering the advanced treatment technique across a multi-site organization. This study aims to evaluate the effectiveness of having a dedicated stereotactic unit operating across multiple radiotherapy treatment centers separated by significant distances. Evaluation is based on a retrospective review of a multi-site stereotactic radiotherapy treatment program currently operating in Victoria, Australia since 2015. Beginning with a dedicated stereotactic unit of two stereotactic trained radiation therapists, supported by radiation oncologists and site physicists, the program expanded from two treatment centers to four within two years. The model of care required the radiation therapists to travel between the Melbourne metropolitan treatment centers to perform stereotactic CT simulations, planning and treatments – with uniform stabilization equipment across the practices to ensure consistency. Remote treatment planning allowed for consistent plan techniques, simple radiation oncologist assessment & peer review, and limited travel. With increased patient demand, the core team expanded further, and by late 2018, included seven specialist radiation therapists across six metropolitan treatment centers and one rural center (3+ hours away). The dedicated stereotactic radiation therapist team expansion occurred via internal and external recruitment, with new team members undergoing three to six months in-house stereotactic training and credentialing. Program expansion to new locations was also facilitated through credentialing of local site RT staff, enabling them to be able to assist core stereotactic members with CT simulation and treatment. A total of 68 patients were treated in the first year of the program. This increased to 157 in 2016, 208 in 2017, and 207 by October 2018. Treatment sites included lung, brain, spine, non-spine bony metastases, nodes, and liver. Average time from CT simulation to treatment start for SBRT cases was 13 days, and 9 days for SRS/SRT cases. Results demonstrate that a dedicated stereotactic unit model of care for a multi-site organization is viable and ensures the highest level of care and quality. Experience gained by a core team performing CT simulation, treatment planning, and delivering treatment to a high volume of patients is invaluable and leads to efficient and safe processes being consistently implemented. The limited size of the team also allows for efficient sharing of information and training. Although the model of care can result in a significant amount of lost time due to travel between treatment centers, it allows for greater patient access, as the treatment is able to be delivered at locations that would otherwise not have had the adequate equipment or skilled radiation oncology team.