The use of adaptive radiation therapy to reduce setup error: a prospective clinical study

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

“…ART had been used clinically for prostate cancer since 1997, with a total of 1269 patients reported as treated at six different institutions [11,12,[13][14][15][16][17][18][19][20][21]. For the reviewed studies reporting CTV extension, the volume included prostate only in 405 patients, prostate and parts of the seminal vesicles in 649 patients and prostate, seminal vesicles and pelvic lymph nodes in one patient.…”

“…The adaptation strategy and timing applied to the majority (1186) of the prostate patients was offline re-plan/re-optimization after the initial 1-2 weeks of treatment to adjust to patient-specific prostate motion relative to bony anatomy ( Table 2, Figures 2 and 3) [11][12][13][14][15][16][17][18]. This ART strategy was used in three single institutional studies.…”

“…This ART strategy was used in three single institutional studies. The earliest implementations, and the pioneers of ART for prostate cancer, were conducted at Beaumont Hospital, US, where 962 patients were treated between the years 1997-2006 [9][10][11][12][13][14][15][16]22]. The target treated was prostate only for 42% of the patients with the remaining 58% receiving irradiation of both prostate and seminal vesicles.…”

“…Their initial implementation, applied to 10 patients, was based on field adjustments for adaptation to the patient-specific set-up errors detected by mega-voltage (MV) radiographs [13]. Subsequently, the workflow was expanded to adaptation of target shape changes through construction of a patient-specific planning target volume (PTV) and finally -for the majority of the patients -this PTV was used for individualized dose escalations until reaching the pre-set criteria for rectum and bladder constraints (Table 2) [11][12][13][14][15][16]22]. The patient-specific PTV, adapted target motion in regard to bony anatomy and was composed of a union formed from four delineated target volumes in the initial CTs to account for shape -and positional changes.…”

Adaptive and robust radiation therapy optimization for lung cancer

“…For instance, de la Zerda et al [2007] proposed algorithms for generating new treatment plans from fraction to fraction in response to changes in the patient geometry detected from cone beam CT (CBCT) images, as well as to the cumulative delivered dose. Another example is Yan et al [1998], who tested an ART method where the daily setup error is measured using portal imaging and is used to correct the treatment if the error becomes sufficiently large. It is worth noting that some studies have considered treatments where the beamlet intensities are altered in real-time during a treatment session, in response to changes in the patient geometry (see for example Mestrovic et al [2007]).…”