DAY-TRIPPER - Feasibility of rapid-access single-fraction stereotactic ablative radiotherapy for cancer patients in regional and rural NSW

Participants will receive single-fraction stereotactic ablative body radiotherapy (SABR) for either a lung tumour or bone metastasis. Treatment will be delivered according to local departmental protocols, Cancer Institute NSW eviQ recommendations and evidence from published clinical trials. The intervention will be delivered by a multidisciplinary radiation oncology team comprising a radiation oncologist, radiation therapists and radiation oncology medical physicists. Radiation oncologists will assess eligibility, prescribe the radiation dose, delineate the treatment target and organs at risk, and approve the treatment plan. Radiation therapists will undertake CT simulation, treatment planning, patient positioning, image guidance and treatment delivery. Medical physicists will perform technical review, treatment-plan verification and patient-specific quality assurance. All staff will have relevant clinical training and experience in SABR and image-guided radiotherapy. The intervention will be delivered to individual participants within the radiation oncology departments at Central Coast Cancer Centre, Calvary Mater Newcastle or North West Cancer Centre, Tamworth. Participants will undergo a dedicated radiotherapy planning CT scan and an individualised radiotherapy plan will then be developed. Before treatment, the plan will undergo standard clinical review and patient-specific quality assurance. Participants with lung tumours will receive 28–34 Gy in one treatment fraction. Participants with bone metastases will receive 12–24 Gy in one treatment fraction, depending on tumour location, size and clinical considerations. The final prescription will be determined by the treating radiation oncologist. On the treatment day, participants will be positioned on a linear accelerator treatment couch and undergo cone-beam CT and, where required, additional X-ray imaging to confirm accurate positioning. Further imaging may be performed during or immediately after treatment to assess intrafraction motion and positioning. The radiation treatment itself will be delivered during a single treatment session, compared to a more standard multi-fraction course over several days or weeks. During Stages 1 and 2, treatment planning and quality-assurance procedures will occur according to each participating department’s usual clinical timeframe. During Stage 3, the same clinical procedures and safety requirements will apply, but the planning and treatment workflow will be streamlined so that CT simulation, planning, quality assurance and treatment are completed within approximately 24 hours. Automation tools may be used to assist contouring, treatment planning and quality assurance; however, all outputs will be reviewed and approved by appropriately qualified clinical staff. As the intervention consists of a single treatment fraction, there is no multi-session treatment adherence requirement. Attendance and successful treatment delivery will be monitored through the oncology information system, treatment records, image-guidance records and linear accelerator delivery logs. Participants who cannot proceed with single-fraction treatment because of clinical, planning, quality-assurance or positioning concerns will be offered an appropriate standard-of-care radiotherapy regimen at the discretion of the treating radiation oncologist.