无模拟放射治疗 (SFRT) 的可行性已得到证实，但缺乏有关其常规护理影响和可扩展性的信息。  方法：在这项单一机构回顾性队列研究中，所有在 XXX 三级癌症中心接受姑息性放射治疗 (RT) 的患者都有资格考虑 SFRT，除非需要面罩固定、立体定向技术或确定剂量。共同主要终点是 SFRT 使用情况、对会诊至 RT 时间的影响以及沙发治疗持续时间。将时间指标与使用未经调整的 Wilcoxon 秩和检验和倾向得分匹配回归接受基于模拟的姑息性 RT 的当代本地队列进行比较。电子患者报告结果 (ePRO) 记录了 2 周的毒性和疼痛反应。  结果：2018 年 4 月至 2024 年 2 月期间，共开展了 2849 个姑息放射课程，其中 1904 个符合资格。 1904 个课程中有 1000 个课程（SFRT 使用率为 52.5%）接受了 SFRT，其中 668 个课程使用 IMRT/VMAT。 788 名患者接受了 SFRT，中位年龄为 71 岁（IQR 61 - 80），其中 59% 为男性，42% 为 ECOG 2-4。 2018-19 年至 2022-24 年期间，SFRT 利用率从 41% 增加至 54%。  SFRT 将中位咨询至 RT 时间从 7.0 天缩短至 5.1 天 (p<0.0001)，对应于治疗 (aATT) 的调整后平均治疗效果为 -2.1 天 (95% CI -2.8 至 -1.3)。 SFRT 将中位沙发治疗持续时间从 17.8 分钟延长至 20.5 分钟（p<0.0001；aATT 2.6 分钟，95% CI 1.3 至 3.9）。 PRO-CTCAE 3 级急性毒性为 9%，放疗后 4 周，基线时有中度/重度疼痛 (≥ 5/10) 的患者疼痛平均减轻 3.5 分（7.1 至 3.6；p<0.0001）。  结论：使用广泛可用的技术，SFRT-1000 队列展示了常规护理的可扩展性以及以患者为中心和工作流程的优势。 SFRT 是一种有吸引力的新范例，可在适应当地要求后在大多数环境中实施。因此，SFRT 开辟了新的途径，有可能改善姑息性 RT 的获取，姑息性 RT 仍然是一个全球性的需求领域。版权所有 © 2024。由 Elsevier Inc. 出版。

The feasibility of simulation-free radiotherapy (SFRT) has been demonstrated but information regarding its routine care impact and scalability is lacking.  METHODS: In this single institution retrospective cohort study, all patients receiving palliative radiotherapy (RT) at an XXX tertiary cancer centre were eligible for consideration of SFRT unless mask immobilisation, a stereotactic technique, or a definitive dose was indicated. Co-primary endpoints were SFRT utilisation, impact on consultation-to-RT time and on-couch treatment duration. Timing metrics were compared to a contemporary local cohort that received simulation-based palliative RT using unadjusted Wilcoxon rank-sum tests and a propensity score-matched regression. Electronic patient-reported outcomes (ePROs) captured 2-week toxicity and pain response.  RESULTS: Between April 2018 and February 2024, 2849 palliative radiation courses were delivered, of which 1904 were eligible. 1000 of the 1904 courses (52.5% SFRT utilisation) received SFRT, including 668 using IMRT/VMAT. 788 individual patients received SFRT and the median age was 71 years (IQR 61 - 80) with 59% being male and 42% being ECOG 2-4. SFRT utilization increased from 41% to 54% between years 2018-19 and 2022-24.  SFRT reduced median consultation-to-RT time from 7.0 to 5.1 days (p<0.0001) corresponding to an adjusted average treatment effect in the treated (aATT) of -2.1 days (95%CI -2.8 to -1.3). SFRT increased median on-couch treatment duration from 17.8min to 20.5min (p<0.0001; aATT 2.6min, 95%CI 1.3 to 3.9). PRO-CTCAE grade 3 acute toxicity was 9% and at 4 weeks post RT patients with moderate/severe pain at baseline (≥ 5/10) had a mean pain reduction of 3.5 points (7.1 to 3.6; p<0.0001).  CONCLUSIONS: Using widely available technologies the SFRT-1000 cohort demonstrates routine care scalability with patient-centred and workflow benefits. SFRT is an attractive new paradigm implementable in most settings following adaptation to local requirements. Thus, SFRT opens new avenues to potentially improve access to palliative RT, which remains a global area of need.Copyright © 2024. Published by Elsevier Inc.