Sir HN Reliance Foundation Hospital recently achieved a major milestone in oncology by successfully implementing simulation-free radiotherapy. Specifically, clinicians treated a head and neck cancer patient using this advanced approach. This landmark procedure combined Surface Guided Radiotherapy (SGRT) and online adaptive radiotherapy for the first time in India. Consequently, the patient received high-precision radiation without requiring a tight thermoplastic mask or a simulation CT scan.

The Clinical Challenge and Patient Profile

The patient, a male in his mid-50s, had a challenging history of mouth cancer. He presented to the emergency department with severe, continuous bleeding from a massively enlarged tumour. Previously, both surgery and standard radiotherapy had failed to control his disease. Therefore, his general health was extremely poor. The clinical team immediately prioritized stabilizing his condition before initiating further local therapy.

In typical cases, conventional radiotherapy for head and neck cancers relies on tight plastic immobilisation masks. Additionally, patients must undergo planning CT scans to prevent target movement. However, the medical team realized that this critical patient could not tolerate such a rigid process. Furthermore, the urgent situation demanded rapid intervention. Thus, the team turned to innovative technological solutions.

Implementing Simulation-Free Radiotherapy in Practice

To deliver rapid palliative treatment, the clinical team successfully deployed an artificial intelligence-driven linear accelerator. Specifically, they utilized the Varian Ethos system in tandem with SGRT. This advanced setup tracks the patient's surface anatomy in real time. Consequently, it removes the need for physical restraints during treatment. Moreover, the system adjusts the radiation beam automatically to account for any subtle movements.

The clinical team avoided the traditional CT simulation step entirely. Instead, they adapted the therapy in real-time based on the daily anatomical changes. As a result, the patient experienced a highly comfortable and completely mask-free treatment process. This approach successfully controlled the life-threatening bleeding. Subsequently, the hospital discharged the patient on May 13, 2026.

According to Dr. Prasad Raj Dandekar, Head of Radiation Oncology, this novel protocol significantly accelerates treatment delivery. Speed is crucial for advanced-stage cancer patients experiencing severe symptoms. Additionally, this technique improves treatment precision, leading to superior clinical outcomes. Ultimately, this approach will help many patients who need urgent and targeted cancer care.

Frequently Asked Questions

Q1: What is simulation-free radiotherapy?

Simulation-free radiotherapy is an innovative workflow that bypasses the traditional dedicated CT simulation scan. Instead, clinicians utilize diagnostic imaging or real-time surface guiding systems to plan and deliver radiation, significantly shortening the time to treatment.

Q2: How does Surface Guided Radiotherapy (SGRT) eliminate the need for immobilisation masks?

SGRT uses advanced 3D camera systems to track a patient's skin surface in real-time. Because the system can detect sub-millimeter movements and automatically pause the radiation beam, clinicians no longer require tight thermoplastic masks to secure the patient.

Q3: Which cancer patients benefit most from this mask-free, simulation-free approach?

This approach is particularly beneficial for palliative cases, advanced-stage patients experiencing severe symptoms like bleeding or pain, and individuals suffering from claustrophobia who cannot tolerate tight physical restraints.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or replace professional judgment. Refer to the latest local and national guidelines for clinical practice.

References

1. India achieves AI breakthrough in cancer care with mask-free, simulationlessradiotherapy - ETHealthworld


2. Advanced Radiation Oncology Technology | Sir H. N. Reliance Foundation Hospital


3. Simulation-free palliative radiotherapy using diagnostic CT scans– is less more? A systematic review - PMC