All-in-one radiotherapy for oncologic emergencies using an integrated CT-linac system: a retrospective cohort study of workflow efficiency and clinical outcomes

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PURPOSE: To evaluate the workflow efficiency, dosimetric accuracy, and clinical outcomes of an all-in-one (AIO) radiotherapy workflow for oncologic emergencies using an integrated CT-linac system. METHODS AND MATERIALS: This retrospective study included 155 patients (Jan 2022-Dec 2025). A template-based AIO protocol was pre-established from conventional planning. Evaluation covered dosimetry, efficiency, and clinical response. RESULTS: All 155 patients received AIO radiotherapy as first treatment. Median prescription target coverage was 95.00% (range, 83.98%-99.98%); 95.48% met clinical goals. Median organ at risk sparing compliance was 100%. Median 2D in-vivo gamma passing rate (GPR) (3%/3 mm) was 97.35% (IQR, 95.20%-98.96%); offline 3D reconstructed GPR (0.01% uncertainty) was 92.26% (IQR, 90.88%-93.80%). Phantom-based GPR (3%/2 mm) was 100% (IQR, 99.87%-100%). Median total workflow time was 24.66 min (IQR, 20.49-31.52). Acute symptom relief occurred in 89.68% of patients. Median ECOG performance status improved from 2 to 1 (P=0.001). In patients with superior vena cava syndrome, median respiratory rate decreased from 24.5 to 20 breaths/min (P=0.001). Median NRS pain score decreased from 3 to 1 (P<0.001). Among bleeding patients, 86.67% had reduced bleeding and 53.33% achieved complete hemostasis. Three-month local control was 96.77%, with mild radiotherapy-related toxicity; median overall survival 5.37 months (95% CI: 4.28-7.01). Cumulative survival rates at 3, 6, 12, 24 months were 63.70%, 45.20%, 29.40%, and 25.10%. CONCLUSIONS: The template-based AIO radiotherapy workflow enables rapid admission-to-treatment, delivering clinically acceptable plans with high accuracy. It allows rapid relief of acute symptoms and widens the window for subsequent therapy.