Metastases remain the leading cause of cancer-related mortality. However, recent studies have reported promising outcomes in clinical trials using multi-site ablative therapies, especially when all sites of disease were treated. Furthermore, the oligometastases hypothesis postulates that a spectrum of metastatic spread exists and that some patients with a limited burden of metastases can be cured with ablative therapy. A good portion of metastatic cancer patients are inflicted with aggressive disease and either travel long distances or are not healthy enough to commit to multiple days of treatment. Even one day can make a substantial difference in treatment outcomes in this overly aggressive disease setting. Nevertheless, as the planning complexity increases, such as in SBRT of multiple metastases, the lead time for RT may also increase up to 10 business days. An efficient workflow/RT technique to deliver the first treatment fraction within a few hours may not only improve outcome but also facilitates its widespread implementation as an effective treatment strategy for treating both palliative and curative diseases.

Our lab is working on with advanced adapative treatment planning strategies to streamline the planning process and provide an on-table (online) workflow for these time critical cases.  This includes automated contouring, highly optimized templates for rapid and robust plan generation and efficient optimization and review.

Top row standard plan.  Bottom row adaptive plan.