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Strategies for Offline Adaptive Biology-Guided Radiotherapy (BgRT) on a PET-Linac Platform.

Bin Cai1, Thomas I Banks1, Chenyang Shen1

  • 1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.

Cancers
|August 14, 2025
PubMed
Summary
This summary is machine-generated.

This study introduces an offline adaptive workflow for Biology-guided Radiotherapy (BgRT) to manage changes during treatment. It ensures safe and accurate radiation delivery by adapting plans based on PET imaging metrics.

Keywords:
BgRTPET signal lossPET-linacoffline adaptive radiotherapy strategies

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Area of Science:

  • Medical Physics
  • Oncology
  • Radiotherapy Technology

Background:

  • Inter-treatment anatomical and biological changes pose challenges for radiotherapy.
  • Adaptive radiotherapy aims to address these dynamic changes for improved treatment efficacy.

Purpose of the Study:

  • To present a structured clinical workflow for offline adaptive Biology-guided Radiotherapy (BgRT).
  • To address challenges in BgRT caused by inter-treatment anatomical and biological variations using the RefleXion X1 PET-linac system.

Main Methods:

  • A decision tree framework for offline adaptation based on Activity Concentration (AC), Normalized Target Signal (NTS), and bounded dose-volume histogram (bDVH%) metrics.
  • Three adaptation strategies: preemptive, partial re-simulation, and full re-simulation.
  • Clinical case studies demonstrating preemptive and partial re-simulation strategies.

Main Results:

  • Preemptive adaptation successfully managed early tumor shrinkage by updating contours and dose distribution.
  • Partial re-simulation addressed significant PET signal changes, requiring same-day PET functional modeling and plan re-optimization.
  • Both strategies demonstrated reduced target volumes and improved Organ at Risk (OAR) sparing without additional patient interventions.

Conclusions:

  • Offline adaptive BgRT workflows offer practical solutions for inter-fractional changes in tumor structure and function.
  • These strategies enhance the safety and accuracy of BgRT delivery.
  • The findings support the clinical adoption of PET-guided radiotherapy and pave the way for online adaptive capabilities.