ESTRO course on Image Guided Radiotherapy in Clinical Practice 2018

ART for un-expected changes

Management system anatomical changes

“decision support system to guide the RTT in prioritizing anatomy changes”

 So, it is used for safety or quality control not for improved dose distribution perse

Radiotherapy

Radiotherapy

Adaptive RT for lung cancer

Tumor reduction during RT

 Zwienen et al 2008  114 patients

 What if you would want to adapt to the shrinking tumor?  Is it predictable?  Is replanning advisable?

 1 pt with progression  40% of patients noticable regression  8% >25% regression in third week  When Atelectasis present at beginning:  Atelectasis changed in 29% (23% smaller, 6% larger)

Radiotherapy

Radiotherapy

Tumor reduction during RT

ART for lung: mid-treatment adaptation

15 patients stage III lung cancer Replanning after 44 of 66 Gy with new target delineation Clinical trial

C/ 1vol%/day

Sonke et al 2010

Radiotherapy

Radiotherapy

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