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Anatomical changes of trending nature

systematic shrinkage of tumor/parotid

volumes during treatment course, OARs

move into high dose

overdosage of OARs as compared to

planning, and potential partial misses of

CTVs

more serious esp. for IMRT due to steep

dose gradients

Wu et al. 2009

(IJROPB 75(3))

example:

planning CT and 6 weeks later…

ESTRO IMRT course 2016

Adaptive Radiotherapy

London April 7th, 2016

-44-

My personal opinion:

High(est) potential for clinical

improvements by repeat imaging and

multiple replanning/adaptation.

Wishful for the future: ‘flag’/red light

identifying patients who benefit most from

one or multiple adaptations