ESTRO course on Image Guided Radiotherapy in Clinical Practice 2018

Example of adaptive strategy in lung cancer RT

Soft tissue match on GTV-T

Evaluate every fraction

Notice large changes

Pleural effusion

GTV-N ~ Surrogate

Medulla ~ Columna

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, Aarhus, DK