Original Article Rapid palliative radiotherapy: comparing IG-IMRT with more conventional approaches Rajiv Samant 1,2 , Lee Gerig 13 , Lynn Montgomery 1 , Miller MacPherson 4,5 , Greg Fox 1 , Robert MacRae 1,2 , Kathy Carty 1 , Steve Andrusyk 1 , Paul Genest 1,2 , Balazs Nyiri 13 1 Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, 2 Faculty of Medicine, University of Ottawa, 3 Department of Physics, Carleton University, Ottawa, Ontario, Canada, 4 Department of Medical Physics, Carlo Fidani Peel Regional Cancer Centre, Mississauga, Ontario, Canada, 5 Department of Radiation Medicine and Physics, The University of Toronto, Toronto, Ontario, Canada Abstract Purpose: To assess the efficiency of an integrated imaging, planning, and treatment delivery system to provide image-guided intensity-modulated radiotherapy (IG-IMRT) for patients requiring palliative radiotherapy (PRT). Methods: Between December 2006 and May 2008, 28 patients requiring urgent PRT were selected to un- dergo single-session megavoltage computed tomography (MV-CT) simulation, IMRT treatment planning, position verification and delivery of the first faction of radiotherapy on a helical Tomotherapy Ò unit. The time required to complete each step was recorded and compared to our standard approach of using either fluoroscopic or CT-based simulation, simplified treatment planning and delivery on a megavoltage unit. Results: Twenty-eight patients were treated with our integrated IG-IMRT protocol. The median age was 72 years, with 61% men and 39% women. The indications for PRT were: painful bone and soft tissue metastasis (75%); bleeding lesions (14%); and other reasons (11%). The areas treated included the following: hip and/or pelvis (42%); spine (36%); and other areas (21%). The most commonly used dose prescription was 20 Gy in five fractions. Average times for the integrated IG-IMRT processes were as follows: image acquisition, 15 minutes; target delineation, 16 minutes; IMRT treatment planning, 9 minutes; treatment position verification, 10 minutes; and treatment delivery, 12 minutes. The average total time was 62 minutes compared to 66 minutes and 81 minutes for fluoroscopic and CT-simulation-based approaches, respectively. The IMRT dose distributions were also superior to simpler plans. Conclusions: PRT with an integrated IG-IMRT approach is efficient and convenient for patients, and has potential for future applications such as single-fraction radiotherapy. Keywords Palliative radiotherapy; IG-IMRT; integrated imagingplanningtreatment BACKGROUND Radiotherapy is a highly effective and essential tool for managing patients with advanced cancer. 1 Palliative radiotherapy (PRT) often Correspondence to: Rajiv Samant, Radiation Oncologist, Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. Email: rsamant@ ottawahospital.on.ca Journal of Radiotherapy in Practice Journal of Radiotherapy in Practice (2010) 9, 143148 Ó Cambridge University Press 2010 doi:10.1017/S1460396909990379 143