Patients meeting the eligibility criteria will be screened for the study and included after informed consent. Patients with pelvic cancers considered for radiotherapy will be planned with two plans—standard VMAT and FFF VMAT with MCO. The planning time will be recorded for both techniques. All planned cases will be subjected to pretreatment review in terms of dose per fraction, monitor units, volume histogram analysis, conformity index, Homogeneity index for targets, and OARs dose parameters as per standard reports. The pretreatment review board will comprise of at least 2 senior radiation oncologists (>10 years’ experience) and one senior physicist. Based on the discussion, the best plan will be chosen for treatment. The comments of the review group will be prospectively recorded. The feasibility of choosing a FFF VMAT plan will be recorded prospectively over two years.

The standard VMAT and FFF VMAT plans will be compared in terms of dosimetric outcomes, planning time and delivery time (Monitor units). The DVH parameters such as target dose coverage, dose to OAR, and normal tissue with all VMAT plans, will be collected for each pelvic cases after approval, and derived values of Conformity index, HI for target, and Gradient index, treatment planning time, beam on time, monitor units will be recorded/estimated for analysis. The patients for whom Standard VMAT or FFF VMAT are approved will be included in the study after informed consent. The patients will receive treatment as per standard practice for the pelvic sites.

Patient specific quality assurance will be carried out for planned case prior to implementation. Point dose and Fluence maps from RTPS for all optimized plans will be transferred to pelvic phantom to deliver and to match delivered fluence against planned fluence with 3% 3mm criteria and 3% for point dose.

The implementation time for treatment delivery (treatment planning to treatment delivery including QA time) will be recorded.

The acute toxicity will be assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 at baseline, weekly during treatment, and post-treatment at one, three and 6 months. The quality of life will be assessed using EORTC QLQ C30 at baseline, radiotherapy completion, and post-treatment at one, three and 6 months.

The quality of life (QoL) of cancer patients will be assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This assessment will be conducted at multiple points: baseline (before the start of radiotherapy), at the completion of radiotherapy, and post-treatment at one, three, and six months.

Baseline Assessment

At baseline, patients will complete the EORTC QLQ-C30 to establish their initial QoL status. This initial assessment will provide a reference point to measure changes in QoL over time.

Radiotherapy Completion

Upon completion of the radiotherapy treatment, patients will again complete the EORTC QLQ-C30. This assessment aims to capture the immediate effects of the treatment on the patients’ QoL, including any acute toxicities or immediate improvements.

Post-Treatment Assessments

Further assessments will be conducted at one, three-, and six-month post-treatment. These follow-up assessments are crucial for monitoring the long-term effects of the radiotherapy, including any late-onset side effects and the overall recovery process. The repeated measures allow for tracking the trajectory of QoL changes over time.

EORTC QLQ-C30 Components

The EORTC QLQ-C30 is a comprehensive tool that evaluates various dimensions of QoL, including Global health status/QoL: Overall perception of health and quality of life. Functional scales: Physical, role, emotional, cognitive, and social functioning.

Symptom scales/items: Fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties.

Implementation

Patients will complete the EORTC QLQ-C30 through self-administration, with assistance available if needed. The data collected will be used to identify trends and patterns in QoL changes, helping to understand the impact of radiotherapy treatment on patients’ lives.