S2833
RTT - RTT education, training, and advanced practice
ESTRO 2026
adenocarcinoma (PDAC), toxicity correlates with SBRT precision due to spatial proximity to the stomach and duodenum. Material/Methods: A stringent IGRT protocol was implemented, utilizing defined matching structures to allow precise and rapid orientation following CBCT acquisition during individual fractions. In treatment planning [Eclipse(TM)], an ITV of IGRT structures was defined using native 4D planning CT (Canon). Additionally, after ≥ 2 hours of fasting, 1/8 liter of oral contrast agent was administered immediately before each fraction to enhance visualization of stomach and duodenum on CBCT. Matching was performed in <2 minutes post CBCT acquisition. From March 2022 through December 2024, 42 patients with locally advanced or recurrent pancreatic adenocarcinoma were treated with ablative doses [Dnear-min(PTV) BED10 ≥ 100 Gy], employing simultaneous integrated protection (SIP) planning technique if necessary. Treatment tolerability was assessed retrospectively according to CTCAE v5. Pantoprazole was administered to all patients with PTV proximity to stomach and duodenum at 40 mg twice daily during and for 3 months following SBRT, then 40 mg once daily for an additional 6 months. Treatment was delivered on TrueBeam HD(TM) with HyperSight(TM) for the final 4 patients. Results: IGRT structures defined during contouring were personalized: for intratumoral biliary stents, only the intratumoral portion with clear radiological boundaries was used for IGRT. Additional IGRT structures included surgical clips in the tumor region and prominent calcifications at arterial branches of the celiac trunk or superior mesenteric artery. Oral contrast administration reliably identified interfractional positional variations of stomach and duodenum, which were incorporated into the matching process. Acute adverse events consisted of 18% Grade 1 fatigue and 15% Grade 1-2 nausea. Only one of 42 patients experienced Grade 3 chronic late toxicity consisting of gastrointestinal bleeding, which was successfully managed endoscopically. All other late toxicities were CTCAE Grade 1-2. Conclusion:
the role creation of a lung APRT, who subsequently led the departmental Motion Management Clinic for lung stereotactic body radiotherapy (SBRT). The APRT applied academic learning in evidence-based practice and change management to guide clinical implementation. The service improved treatment workflow and patient management for over 100 patients by streamlining scheduling efficiency for SBRT simulations and reducing CT simulation time through a pre-simulation checklist. Reflective learning and stakeholder engagement were key enablers of successful implementation.The APRT also supported the establishment of lung SBRT services at a satellite institution, developing staff training materials, competency frameworks, and standardised protocols. These initiatives strengthened cross-institution collaboration, enhanced staff confidence in SBRT delivery, and demonstrated the value of education- driven role development. Conclusion: A structured collaboration between academia and clinical practice provides a sustainable and transferable model for APRT development. This lung APRT training framework illustrates the potential of postgraduate education to build advanced practice capacity, improve clinical services and support future workforce development in radiation therapy. Keywords: Advanced practice, training, radiotherapy References: Chan, K., Harnett, N., & Tsang, Y. (2025). A step towards global understanding of advanced practice radiation therapist clinical activities: International Delphi consensus. Journal of medical imaging and radiation sciences, 57(1), 102138. Advance online publication. https://doi.org/10.1016/j.jmir.2025.102138 Digital Poster 3033 CT-IGRT Management for SBRT of Pancreatic Cancer and Analysis of Acute and Chronic Toxicity Lukas Seiss 1,2 , Thomas Konrad 1 , Ursula Temmel 1 , Mathias Thurner 2 , Joerg Lehner 1 , Zoltan Loecsei 1 , Peter Winkler 1 , Thomas B Brunner 2,1 1 LKH University Hospitals Graz, Department of Radiation Oncology, Graz, Austria. 2 Medical University of Graz, Department of Radiation Oncology, Graz, Austria Purpose/Objective: SBRT in the upper abdomen is a locally effective treatment modality for tumors of the pancreas. However, IGRT is complex due to frequently limited visualization in cone-beam CT, and fiducial markers cannot always be employed. The objective was to develop a workflow enabling precise SBRT delivery in the upper abdomen. Particularly for pancreatic ductal
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