Adaptive radiotherapy strategies for pelvic tumors – a systematic review of clinical implementations

Abstract

(2016) Adaptive radiotherapy strategies for pelvic tumors -a systematic review of clinical implementations, Acta Oncologica, 55:8,[943][944][945][946][947][948][949][950][951][952][953][954][955][956][957][958]

Online daily assessment of dose change in head and neck radiotherapy without dose‐recalculation

“…Plan adaptation has been reported for various treatment sites including lung,7 prostate,8, 9, 10 and head and neck cancers 11, 12. Across all treatment sites, adaptation is necessary due to tumor shrinkage, weight loss or other significant anatomical changes that impact the dose distribution (e.g., lung collapse or re‐inflation).…”

The promise of adaptive radiotherapy for pelvic tumors: “too high cost for too little result” or “a low cost for a significant result”?

“…Despite the relatively limited clinical experience, well reviewed by Thornqvist et al [1], the points briefly discussed here clearly suggest that a promising future may be expected for ART for pelvic tumors. The availability in the near future of reliable models able to predict outcome based on specific patient and tumor characteristics is likely to lead the evolution of ART toward increasingly customized approaches.…”

“…The first family (1) mainly includes experiences following Yan's original approach, trying to adapt the margins (accompanied by re-planning) to the individual patient's characteristics after an adequate sampling of set-up error measurements taken during the initial phase of the treatment; it dealt mostly with prostate cancer and, more marginally, with its extension to deformable targets, as in the case of bladder cancer. Very interestingly, although this approach was the first to be implemented in the 1990s, as may be seen in Table 2 of the Thornqvist et al review [1], only eight series have been published (five for prostate and three for bladder cancer) with the majority of the data referring to patients treated in the 1990s and in the early 2000s. On the contrary, the second category (2), mainly represented by on-line plan selection approaches for cervix and bladder cancer seems to be currently quite ''vital'', as confirmed by the publication of significant new experiences during the time of preparation of the review [5][6][7].…”

“…The sound and thorough review by Thornqvist et al [1] on the clinical experience with adaptive radiotherapy (ART) in the treatment of pelvic tumors arrives in a ''hot'' and quite timely moment. This approach was originally suggested almost two decades ago [2] as a sort of ''visionary'' way to drastically minimize the risk of missing the tumor and, more importantly, to reduce the volume of irradiated normal tissues when applying (large) margins to gross tumor volume (GTV)/ clinical target volume (CTV).…”

Bridging imaging and therapy: the role of medical physics in development of precision cancer care

“…Furthermore, in radiotherapy, medical images provide the information necessary to delineate the tumor and organs at risk. Radiotherapy is a completely digital process, where developments are seen among others in delivery techniques and image-guided adapted strategies [5][6][7]. With the aim of cancer care to move from the concept of 'one-size-fits-all' to individualized treatment, the term 'Precision cancer care' could also encompass radiotherapy tailored to the individual patient's medical imagebased profile in addition to the genetic profile.…”