Adaptive Radiation Therapy (ART) Strategies and Technical Considerations: A State of the ART Review From NRG Oncology

Feasibility of Continual Deep Learning-Based Segmentation for Personalized Adaptive Radiation Therapy in Head and Neck Area

“…They generated up to 2000 synthetic CT from 30 well-defined segmentations for training DLS resulting in DSC of 0.74-0.83 [50]. Currently, various DIR software is recommended for ART; DLS is considered as a potential next step in near future [1,51]. In this context, the current method of continual training with initial planning CT (DLSm) for ART could represent a high-quality training data acquisition.…”

“…Particularly, intensity-modulated radiation therapy (IMRT) could achieve a homogeneous dose distribution in the target area, minimizing the radiation dose to normal organs. Moreover, the evolution of imageguided RT has led to adaptive RT (ART), which accounts for anatomical changes arising from weight loss or tumor regression during RT, aiming to provide accurate and precise dose delivery [1]. Interestingly, planning computed tomography (CT) data of the same 2 of 19 patient with temporal changes during RT is used for each ART.…”

Induction Strategy for Locally Advanced Thymoma

“…The application of ART, or modifying the physical plan during the radiotherapy process, is becoming increasingly available in clinical practice. ART provides powerful potential for minimizing radiation-related injury while escalating or deescalating target doses based on the dose to organs at risk (38). ART is worthwhile especially in tumors that shrink rapidly during radiation therapy.…”

Future mainstream platform for online adaptive radiotherapy will be using on‐board MR rather than on‐board (CB) CT images

“…With this change, the need to verify daily radiotherapy dose and adapt the radiotherapy plan according to daily anatomy has become essential. 4 Currently, the most common platforms for online adaptive radiotherapy (ART) include MRI-guided ART (MRgART) and CT (or cone-beam CT)-guided ART (CTgART), both of which have only been adopted by a handful of largescale hospital-based cancer centers around the world. As more experience is collected and technology matures, one would hope that advanced online ART platforms should become more affordable and accessible to a larger community.…”

“…As several major non‐inferiority phase 3 clinical trial studies published their promising results, 1,2 and as the reimbursement pattern is reforming from fee‐for‐service payment to episode‐based payment, 3 the radiation oncology field is undergoing a major paradigm shift, from a majority of standard fractionation treatments to more hypo‐fractionation and stereotactic body radiotherapy (SBRT). With this change, the need to verify daily radiotherapy dose and adapt the radiotherapy plan according to daily anatomy has become essential 4 . Currently, the most common platforms for online adaptive radiotherapy (ART) include MRI‐guided ART (MRgART) and CT (or cone‐beam CT)‐guided ART (CTgART), both of which have only been adopted by a handful of large‐scale hospital‐based cancer centers around the world.…”