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Cone Beam CT-guided Online Adaptive Radiotherapy for Prostate Stereotactic Body Radiation Therapy.

D M McClatchy¹, J Pursley², C Esposito³

¹Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Practical Radiation Oncology

|July 10, 2026

Summary

CT-guided online adaptive radiotherapy (CTgART) for prostate SBRT is feasible and reproducible. This method significantly improves target coverage and organ-at-risk sparing in patients undergoing treatment.

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Area of Science:

Radiation Oncology
Medical Physics

Background:

CT-guided online adaptive radiotherapy (CTgART) is an emerging technique for prostate stereotactic body radiotherapy (SBRT).
Limited data exists on its feasibility and dosimetric benefits in large, multi-center studies.

Purpose of the Study:

To evaluate the feasibility and quantify dosimetric improvements of CTgART for prostate SBRT in a multi-center cohort.
To assess the time efficiency and reproducibility of the adaptive planning process.

Main Methods:

Retrospective analysis of 74 prostate cancer patients treated with 5-fraction CTgART SBRT across two centers.
Collection of adaptive planning timestamps, daily contoured volumes, and dose-volume histogram (DVH) data.
Comparison of scheduled vs. adapted plans, analyzing planning time, image shifts, and DVH metrics.

Main Results:

Adaptation occurred in 95% of fractions, with 81% of patients receiving 5 adapted fractions. Mean planning time was 18.7 minutes.
Daily target volumes remained close to simulation volumes (90% within 5cc).
Significant DVH improvements observed in 85% of fractions, notably PTV V100% (52%) and Rectum V15Gy (37%).

Conclusions:

CTgART is a timely and reproducible method for prostate SBRT.
The technique substantially enhances dosimetric outcomes for both target coverage and organ-at-risk sparing.