Abstract
The techniques employed in palliative radiation therapy are highly variable, ranging from basic (2D/3D-conformal) to more advanced (beam modulation and stereotactic techniques), and their relative use has not previously been formally investigated at a national level. The purpose of this work was to assess the current utilisation of palliative techniques and technologies in Australia and New Zealand (ANZ).INTRODUCTIONThe techniques employed in palliative radiation therapy are highly variable, ranging from basic (2D/3D-conformal) to more advanced (beam modulation and stereotactic techniques), and their relative use has not previously been formally investigated at a national level. The purpose of this work was to assess the current utilisation of palliative techniques and technologies in Australia and New Zealand (ANZ).A voluntary, anonymous, internet-based, RANZCR approved survey was offered to all practising radiation oncology (RO) Fellows in ANZ. Participants selected their preferred methods of managing patients in five case studies involving bone, brain, lung metastases and locally advanced lung cancer.METHODSA voluntary, anonymous, internet-based, RANZCR approved survey was offered to all practising radiation oncology (RO) Fellows in ANZ. Participants selected their preferred methods of managing patients in five case studies involving bone, brain, lung metastases and locally advanced lung cancer.From October 2022 to February 2023, 146 of 485 eligible participants (30%) responded. In all, 61% and 81% would treat an uncomplicated breast cancer solitary spinal metastasis with stereotactic body radiation therapy routinely and ideally, respectively; 11% and 32% would treat a solitary lung cancer brain metastasis with dedicated stereotactic radiosurgery routinely and ideally; 36% and 56% would treat multiple low-volume brain metastases with a stereotactic technique routinely and ideally. There was negligible difference in the routine and preferred use of advanced technologies for a solitary bowel cancer lung metastasis; 69% and 77% would treat a locally advanced primary lung cancer with an advanced technique routinely and ideally. Relative to Australia, NZ ROs routinely treat uncomplicated solitary spinal metastases (P < 0.001), solitary brain metastases (P < 0.001), multiple low-volume brain metastases (P < 0.02), and locally advanced primary lung cancer (P < 0.001) more commonly with basic technologies, mainly due to limited local availability of advanced technology and departmental waiting lists.RESULTSFrom October 2022 to February 2023, 146 of 485 eligible participants (30%) responded. In all, 61% and 81% would treat an uncomplicated breast cancer solitary spinal metastasis with stereotactic body radiation therapy routinely and ideally, respectively; 11% and 32% would treat a solitary lung cancer brain metastasis with dedicated stereotactic radiosurgery routinely and ideally; 36% and 56% would treat multiple low-volume brain metastases with a stereotactic technique routinely and ideally. There was negligible difference in the routine and preferred use of advanced technologies for a solitary bowel cancer lung metastasis; 69% and 77% would treat a locally advanced primary lung cancer with an advanced technique routinely and ideally. Relative to Australia, NZ ROs routinely treat uncomplicated solitary spinal metastases (P < 0.001), solitary brain metastases (P < 0.001), multiple low-volume brain metastases (P < 0.02), and locally advanced primary lung cancer (P < 0.001) more commonly with basic technologies, mainly due to limited local availability of advanced technology and departmental waiting lists.Participants generally favoured treating with advanced techniques and technologies in palliative settings, if available, but there were notable disparities between the two countries. Enhanced local access and clinical training may facilitate optimal utilisation of advanced technologies and improve clinical outcomes.CONCLUSIONParticipants generally favoured treating with advanced techniques and technologies in palliative settings, if available, but there were notable disparities between the two countries. Enhanced local access and clinical training may facilitate optimal utilisation of advanced technologies and improve clinical outcomes.