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Adaptive Radiotherapy at GenesisCare UKAmanda Jones and Jacqui Dorney Nov 2016
Page 2
• 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
Page 3
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
Page 4
Pre-treatment Imaging
Treatment Planning Onset Imaging
Image Registration
and Correction
Treatment delivery
Where are we?
Page 5
Where are we?
Pre treatment Imaging
Treatment Planning Onset Imaging
Treatment Delivery
Image Registration and
Correction
Treatment AssessmentAdaptive planning
Page 6
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
Page 7
• 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
Page 8
Current Projects
Courtesy of Stuart Williams GCUK Portsmouth
Page 9
Current Projects
Courtesy of Stuart Williams GCUK Portsmouth
Plan of the Day – Bladder filling
Page 10
Current GCUK Project
Courtesy of Steve Murphy GCUK Southampton
Page 11
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.