[Overview of adaptive radiotherapy in 2019: From implementation to clinical use]

Area of Science:

• Radiation Oncology
• Medical Physics

Background:

• Intensity modulated radiotherapy and image guided radiotherapy enhance precision.
• Anatomical variations during treatment can lead to under-dosing or over-dosing.
• Adaptive radiotherapy (ART) strategies are crucial for compensating these variations.

Purpose of the Study:

• To provide an overview of available ART strategies.
• To discuss ART in the context of emerging MR-Linac technology.
• To describe the tools and requirements for implementing ART.

Main Methods:

• Review of current and emerging adaptive radiotherapy strategies (offline, online, hybrid, real-time).
• Description of essential ART tools: auto-segmentation, deformable image registration, daily dose calculation, and dose accumulation.
• Consideration of implementation requirements including quality assurance, organization, and multidisciplinary training.

Main Results:

• ART strategies offer solutions to mitigate risks associated with anatomical variations.
• MR-Linac devices necessitate advanced ART approaches.
• Successful ART implementation relies on robust quality assurance and teamwork.

Conclusions:

• Adaptive radiotherapy is vital for maintaining treatment accuracy and safety.
• A multidisciplinary approach and rigorous quality assurance are essential for effective ART implementation.
• ART, especially with MR-Linac, represents a significant advancement in personalized cancer treatment.