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Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management

Background: Hypo-fractionation can be an effective strategy to lower costs and save time, increasing patient access to advanced radiation therapy. To demonstrate this potential in practice within the context of temporal evolution, a twenty-year analysis of a representative radiation therapy facility...

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Autores principales: Tomatis, Stefano, Mancosu, Pietro, Reggiori, Giacomo, Lobefalo, Francesca, Gallo, Pasqualina, Lambri, Nicola, Paganini, Lucia, La Fauci, Francesco, Bresolin, Andrea, Parabicoli, Sara, Pelizzoli, Marco, Navarria, Pierina, Franzese, Ciro, Lenoci, Domenico, Scorsetti, Marta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378035/
https://www.ncbi.nlm.nih.gov/pubmed/37504370
http://dx.doi.org/10.3390/curroncol30070510
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author Tomatis, Stefano
Mancosu, Pietro
Reggiori, Giacomo
Lobefalo, Francesca
Gallo, Pasqualina
Lambri, Nicola
Paganini, Lucia
La Fauci, Francesco
Bresolin, Andrea
Parabicoli, Sara
Pelizzoli, Marco
Navarria, Pierina
Franzese, Ciro
Lenoci, Domenico
Scorsetti, Marta
author_facet Tomatis, Stefano
Mancosu, Pietro
Reggiori, Giacomo
Lobefalo, Francesca
Gallo, Pasqualina
Lambri, Nicola
Paganini, Lucia
La Fauci, Francesco
Bresolin, Andrea
Parabicoli, Sara
Pelizzoli, Marco
Navarria, Pierina
Franzese, Ciro
Lenoci, Domenico
Scorsetti, Marta
author_sort Tomatis, Stefano
collection PubMed
description Background: Hypo-fractionation can be an effective strategy to lower costs and save time, increasing patient access to advanced radiation therapy. To demonstrate this potential in practice within the context of temporal evolution, a twenty-year analysis of a representative radiation therapy facility from 2003 to 2022 was conducted. This analysis utilized comprehensive data to quantitatively evaluate the connections between advanced clinical protocols and technological improvements. The findings provide valuable insights to the management team, helping them ensure the delivery of high-quality treatments in a sustainable manner. Methods: Several parameters related to treatment technique, patient positioning, dose prescription, fractionation, equipment technology content, machine workload and throughput, therapy times and patients access counts were extracted from departmental database and analyzed on a yearly basis by means of linear regression. Results: Patients increased by 121 ± 6 new per year (NPY). Since 2010, the incidence of hypo-fractionation protocols grew thanks to increasing Linac technology. In seven years, both the average number of fractions and daily machine workload decreased by −0.84 ± 0.12 fractions/year and −1.61 ± 0.35 patients/year, respectively. The implementation of advanced dose delivery techniques, image guidance and high dose rate beams for high fraction doses, currently systematically used, has increased the complexity and reduced daily treatment throughput since 2010 from 40 to 32 patients per 8 h work shift (WS8). Thanks to hypo-fractionation, such an efficiency drop did not affect NPY, estimating 693 ± 28 NPY/WS8, regardless of the evaluation time. Each newly installed machine was shown to add 540 NPY, while absorbing 0.78 ± 0.04 WS8. The COVID-19 pandemic brought an overall reduction of 3.7% of patients and a reduction of 0.8 fractions/patient, to mitigate patient crowding in the department. Conclusions: The evolution of therapy protocols towards hypo-fractionation was supported by the use of proper technology. The characteristics of this process were quantified considering time progression and organizational aspects. This strategy optimized resources while enabling broader access to advanced radiation therapy. To truly value the benefit of hypo-fractionation, a reimbursement policy should focus on the patient rather than individual treatment fractionation.
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spelling pubmed-103780352023-07-29 Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management Tomatis, Stefano Mancosu, Pietro Reggiori, Giacomo Lobefalo, Francesca Gallo, Pasqualina Lambri, Nicola Paganini, Lucia La Fauci, Francesco Bresolin, Andrea Parabicoli, Sara Pelizzoli, Marco Navarria, Pierina Franzese, Ciro Lenoci, Domenico Scorsetti, Marta Curr Oncol Article Background: Hypo-fractionation can be an effective strategy to lower costs and save time, increasing patient access to advanced radiation therapy. To demonstrate this potential in practice within the context of temporal evolution, a twenty-year analysis of a representative radiation therapy facility from 2003 to 2022 was conducted. This analysis utilized comprehensive data to quantitatively evaluate the connections between advanced clinical protocols and technological improvements. The findings provide valuable insights to the management team, helping them ensure the delivery of high-quality treatments in a sustainable manner. Methods: Several parameters related to treatment technique, patient positioning, dose prescription, fractionation, equipment technology content, machine workload and throughput, therapy times and patients access counts were extracted from departmental database and analyzed on a yearly basis by means of linear regression. Results: Patients increased by 121 ± 6 new per year (NPY). Since 2010, the incidence of hypo-fractionation protocols grew thanks to increasing Linac technology. In seven years, both the average number of fractions and daily machine workload decreased by −0.84 ± 0.12 fractions/year and −1.61 ± 0.35 patients/year, respectively. The implementation of advanced dose delivery techniques, image guidance and high dose rate beams for high fraction doses, currently systematically used, has increased the complexity and reduced daily treatment throughput since 2010 from 40 to 32 patients per 8 h work shift (WS8). Thanks to hypo-fractionation, such an efficiency drop did not affect NPY, estimating 693 ± 28 NPY/WS8, regardless of the evaluation time. Each newly installed machine was shown to add 540 NPY, while absorbing 0.78 ± 0.04 WS8. The COVID-19 pandemic brought an overall reduction of 3.7% of patients and a reduction of 0.8 fractions/patient, to mitigate patient crowding in the department. Conclusions: The evolution of therapy protocols towards hypo-fractionation was supported by the use of proper technology. The characteristics of this process were quantified considering time progression and organizational aspects. This strategy optimized resources while enabling broader access to advanced radiation therapy. To truly value the benefit of hypo-fractionation, a reimbursement policy should focus on the patient rather than individual treatment fractionation. MDPI 2023-07-22 /pmc/articles/PMC10378035/ /pubmed/37504370 http://dx.doi.org/10.3390/curroncol30070510 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Tomatis, Stefano
Mancosu, Pietro
Reggiori, Giacomo
Lobefalo, Francesca
Gallo, Pasqualina
Lambri, Nicola
Paganini, Lucia
La Fauci, Francesco
Bresolin, Andrea
Parabicoli, Sara
Pelizzoli, Marco
Navarria, Pierina
Franzese, Ciro
Lenoci, Domenico
Scorsetti, Marta
Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management
title Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management
title_full Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management
title_fullStr Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management
title_full_unstemmed Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management
title_short Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management
title_sort twenty years of advancements in a radiotherapy facility: clinical protocols, technology, and management
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378035/
https://www.ncbi.nlm.nih.gov/pubmed/37504370
http://dx.doi.org/10.3390/curroncol30070510
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