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Adaptive Radiotherapy at GenesisCare UKAmanda Jones and Jacqui Dorney Nov 2016
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• Adaptive radiation therapy is a closed-loop radiation treatment process where the treatment plan can be modified using a systematic feedback of measurements
• Adaptive radiation therapy intends to improve radiation treatment by systematically monitoring treatment variations and incorporating them to re-optimize the treatment plan early on during the course of treatment
• In this process, field margin and treatment dose can be routinely customized to each individual patient to achieve a safe dose escalation.
Yan et al (1997)
What is Adaptive Radiotherapy
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Physical• OAR volume differences Inter and intrafractional
– Inter – Daily IGRT– Intra – VMAT plans
• Target volume difference Interfractional replan• Target position difference Inter and intrafractional
– Inter daily IGRT and replans– Intra – online dose recalculation/ plan of the day
Biological• Target Localisation• Hypoxia Identification• Cell Proliferation
What is Adaptive Radiotherapy
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Pre-treatment Imaging
Treatment Planning Onset Imaging
Image Registration
and Correction
Treatment delivery
Where are we?
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Where are we?
Pre treatment Imaging
Treatment Planning Onset Imaging
Treatment Delivery
Image Registration and
Correction
Treatment AssessmentAdaptive planning
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Where are we?Physical• OAR volume differences
– Inter – Daily IGRT– Intra – VMAT plans
• Target volume difference – Interfractional - Re-plan
• Target position difference– Inter - daily IGRT and re-plans
Intra – DIBH
Biological• Target Localisation• Hypoxia Identification• Cell Proliferation
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• RAIDER is a phase II, international, parallel cohort, three arm, two stage randomised trial of adaptive tumour focused radiotherapy for bladder cancer.
• ARTFORCE is a randomized phase II trial for 268 patients with a factorial 2 by 2 design: cisplatin versus Cetuximab and standard RT versus redistributed RT. Patients with locally advanced, biopsy confirmed squamous cell carcinoma of the oropharynx, oral cavity or hypopharynx are eligible.
Current National Trials
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Current Projects
Courtesy of Stuart Williams GCUK Portsmouth
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Current Projects
Courtesy of Stuart Williams GCUK Portsmouth
Plan of the Day – Bladder filling
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Current GCUK Project
Courtesy of Steve Murphy GCUK Southampton
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Physical• OAR volume/position difference
– Daily IGRT with plan of the day options
• Target volume difference Interfractional re-plan– Daily IGRT with plan of the day options
• Target position difference Inter and intrafractional– Inter - Daily IGRT and offline re-plans– Online dosimetry with re-plan
Intra – Intrafractional IGRT wit online compensation
What next?Biological• Target Localisation• Hypoxia Identification• Cell Proliferation
Thank-youReferencesYan D1, Vicini F, Wong J, Martinez A, (1997), Adaptive radiation therapy, Phys Med Biol. 1997 Jan;42(1):123-32.
