ASMR

Example of adaptive strategy in lung cancer RT

Soft tissue match on GTV-T

Evaluate every fraction

Notice large changes

GTV-N ~ Surrogate

Medulla ~ Columna

Pleural effusion

Atelectasis

Pneumonia

Normal tissue

GTV-T

Deviation above tolerance

Large change observed

Same deviation 3 consecutive fx

Same change 3 consecutive fx

Adaptive treatment plan – correct systematic deviation

Adaptive treatment plan – correct systematic change

Courtesy of D Møller & L Hoffman, Århus, DK