KEY POINTS
- This single-centre retrospective study evaluated a “non-classical” rapid-access palliative RT pathway implemented between 2018 and 2024 using existing departmental resources rather than a dedicated RAPRT clinic, protected LINAC slots, or dedicated palliative dosimetrist.
- The cohort included 775 patients receiving 848 courses; median age was 63 years, 40% had ECOG 3–4, and 37% were hospitalized. Bone was the most common treatment site (47%), followed by the thorax (19%).
- Treatment was deliberately short: 797 extracranial courses, representing 94% of all courses, used a single fraction. Fifty-six patients received more than one treatment course and 15 underwent re-irradiation.
- Median time from referral to radiation oncology consultation was only 1 day. Median total treatment-process time was 109 minutes, while median total time spent in the radiotherapy centre was 207 minutes.
- Simulation and dosimetry remained the main workflow bottlenecks, accounting for approximately 24% and 31% of treatment-process time, respectively.
- Hospitalized patients had significantly shorter treatment-process times than outpatients (p=0.002), and treatment site was also associated with treatment time (p=0.001). Median survival for the overall cohort was only 93 days, emphasizing the importance of minimizing treatment burden.
- The model benefited from two CT simulators dedicated to radiation oncology and favorable local authorization pathways. Symptom response, patient-reported outcomes, satisfaction, hospitalization effects, and integration with specialist palliative care were not systematically evaluated.
CLINICAL TAKEAWAY
Rapid palliative RT may be achievable through workflow design rather than a separate dedicated service. For departments unable to build a formal RAPRT clinic, structured electronic coordination, flexible simulation access, and greater use of single-fraction treatment may offer a practical alternative, although generalizability will depend heavily on local resources.