Carpe Diem: Making the Most of Plan-of-the-Day for Cervical Cancer Radiation Therapy

Empirical analysis of a plan‐of‐the‐day strategy to approximate daily online reoptimization for prostate CBCT‐guided adaptive radiotherapy

“…The potential and successful implementation of such a strategy for sites like these have been extensively described. 23,24,[35][36][37]39,[25][26][27][28][29]31,32,34 The implementation of POD strategies described here differs from the conventional implementation in a number of notable ways. While the position and orientation of the prostate and seminal vesicles are also heavily influenced by bladder filling, they are similarly influenced by variable rectal filling.…”

“…Furthermore, because multiple levels of bladder filling can be achieved during a single CT simulation appointment, treatment sites like these facilitate the creation of multiple treatment plans upfront, contributing to a plan library available even at the first treatment fraction. The potential and successful implementation of such a strategy for sites like these have been extensively described 23,24,35–37,39,25–29,31,32,34 …”

“…Alternatives to online ART replanning that can account for some changes in shape have been described. Notably, selecting a plan from an existing plan library is an effective means when various modes of anatomic change or recurring anatomic configurations are observed 23–39 . These plan‐of‐the‐day (POD) techniques have the benefit of being tailored (to a degree) to the anatomy of each fraction but without requiring the replanning effort necessitated by current online ART workflows.…”

Predicting cervical cancer target motion using a multivariate regression model to enable patient selection for adaptive external beam radiotherapy

“…The challenge is ensuring target coverage, while reducing irradiation of normal tissues. Consequently, practice has evolved from applying large population-based margins, to creating individualised internal target volumes (ITVs), to some centers now adopting an adaptive plan-of-the-day (PotD) approach [3] . Both ITV and PotD approaches require two planning CT scans: one with a full bladder (CT-FB) and another with an empty bladder (CT-EB).…”

“…Fully online adaptive radiotherapy involves re-segmentation and re-planning while the patient is set up for treatment, and there is emerging technology to achieve this for cervical cancer [4] , [5] . PotD and daily online replanning have led to improved dose-volume metrics compared to non-adaptive approaches in cervical cancer [3] and other tumour types [6] , [7] .…”