ESTRO course on Image Guided Radiotherapy in Clinical Practice 2018

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Adaptive RT

Coen Rasch

Radiotherapy

Radiotherapy

A reminder:

What is adaptive RT

 GTV  Imaging, Clinical investigation  CTV  Statistics, Experience  PTV / ITV  Possible positions of the CTV  Treated Volume / irradiated Volume  Collateral damage

 Adaptive radiotherapy (ART) is an approach to correct for variations in geometry of tumor and bystander anatomy with repeated (imaging-based (?)) modification of treatment delivery

•IGRT •ART

•IMRT

Schwartz et al Curr Oncol Rep 2012

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Radiotherapy

Radiotherapy

Ask yourself:

How does adaptive RT translate

 Do I want adaptation for:

 (4D) adaptive RT is RT with time weighted adaptation  I.e.

 1) Day to day, random changes  Bladder, cervix  2) Expected changes  Head and Neck

 Measuring and correcting for day to day variation

 Adaptation of RT based upon (anatomical,

functional, biological) changes during RT either expected (weight loss, shrinkage) or unexpected like atelectasis

 3) Random occurring systematic changes?  (base line shift, suddenly changed anatomy in e.g. Lung)

 Basics: it is per patient, not per group

Radiotherapy

Radiotherapy

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