Metastatic cord compression occurs in 5-10% of patients with cancer often affected the ends stages of a patient's illness. The benefit of palliation is directly related to the speed of treatment, National Institute of Health and Care Excellence (NICE) guidelines recommend that radiotherapy is given within 24 hours of a decision to treat. A recent audit of the current referrals and pathway showed the average time from consultation to treatment is 2.10 days (SD 12.2 days). This audit concluded the need to improve the speed of access to care.
The current pathway includes a scan for diagnosis (MRI), a visit for a planning CT and time to plan the treatment before treatment delivery. This can take many hours or even days. To provide quicker access to care it is intended to use the MR Linac with an integrated adaptive radiotherapy platform, to deliver a scan, plan and treat model in a single appointment.
Preliminary work has modelled dose differences due to the presence of a magnetic field, known as the electron return effect and developed an MR only workflow using a simple planning technique to enable the online scan, plan and treat model.
The primary objective is to test the feasibility of a one-stop MR guided palliative radiotherapy programme for patients with MSCC.
Secondary objectives are:
- To reduce overall time from decision to treat to treatment delivery.
- Reduce the number of appointments and procedure required to provide palliative radiotherapy for patients with MSCC.
- Compare participant experience of MSCC treatment on the MR Linac to the current standard of care pathway.
This is a single centre, non-randomised clinical trial. All patients referred for radiotherapy to treat MSCC who can provide informed consent can be considered. Participants will be asked to have treatment on the MR Linac within a single appointment and complete an experience questionnaire. If participants would not like to have treatment on the MRL or do not meet the inclusion criteria participants can continue the standard of care pathway with the addition of completing an experience questionnaire and the data and answers will be used for analysis. If patients would not like to participate, standard of care radiotherapy will be delivered and this patient data will not be used for this study.
The study is expected to recruit up to 72 participants over a 2-year period using a 1:2 ratio. Up to 24 participants will be recruited to the MR Linac Arm of the study. This sample is based on resource constraints, the MR Linac can accommodate one patient per month on average. Recruitment will be a 1:2 ratio to reduce bias to the investigational arm.
To test the aim, to improve the speed of access of care, timings will be collected at certain time points throughout the pathway:
- Clinical decision to treat the participant
- Time of treatment consent
- Time of Radiotherapy Planning scan (Standard of Care only)
- Time of Radiotherapy Completion
The study will consist of:
- MSCC team confirm diagnosis & organise for the patient to be transferred to the Christie. (Day 0)
- Referral to Radiotherapy (Day 0)
- Approached in person by the Research Team & MRI screening. (Day 1)
- Consent to Radiotherapy. (Day 1)
- Consent to Study. (Day 1)
- Optional Equality diversity and inclusivity (EDI) Questionnaire completed. (Day1)
- Patient prepared in MRL clinical system or given RTP appointment. (Day 1)
- Radiotherapy treatment on MRL or Conventional Linac. (Day 1 -7)
- Patient experience questionnaire completed. (Same day as treatment)
- Patient outcomes will be determined from clinical notes. (1,3,6,12 months following treatment)
A participant is free to withdraw from the clinical trial at any point without giving a reason.
This study will run for 3 years in total, 2 years for recruitment plus one year for follow up unless early termination is required.
