Personalizing radiotherapy with adaptive radiotherapy: Interest and challenges.

Area of Science:

• Radiation Oncology
• Medical Physics
• Cancer Treatment

Background:

• Adaptive radiotherapy (ART) enables personalized cancer treatment by adjusting to daily anatomical changes.
• Historically performed offline, ART now offers daily online adaptation for enhanced precision.

Purpose of the Study:

• To detail the benefits, advantages, constraints, and limitations of online ART modalities.
• To evaluate clinical situations where online ART is particularly indicated.
• To discuss challenges and solutions for future online ART development.

Main Methods:

• Description of online adaptive radiotherapy processes.
• Evaluation of MR-linear accelerators and CBCT-linear accelerators for online ART.
• Analysis of technological advancements including AI and multimodal imaging.

Main Results:

• Online ART allows daily customization for optimal target coverage and minimized margins.
• It reduces toxicity and enables tumor dose escalation.
• Technological advancements in imaging and AI are crucial for its implementation.

Conclusions:

• Online ART, available on MR- and CBCT-linear accelerators, offers significant advantages in cancer treatment personalization.
• Further development is needed to address challenges and expand its clinical application.
• This technology promises to minimize toxicity and improve therapeutic outcomes.