Adaptive Radiation Therapy 

Introduction and aim

Adaptive radiotherapy (ART) is an advanced form of radiation therapy used in the treatment of cancer. Unlike traditional radiotherapy, which relies on a predefined treatment plan based on initial imaging (Picture A: standard non-adaptive RT), ART allows for adjustments throughout the treatment course. These adjustments are based on changes in the patient's anatomy, tumor size, position, and other biological factors. These adjustments can be performed offline when the patient is not on the treatment couch (Picture B: Offline adaptive RT) or online when the patient is on the treatment couch (Picture C: online adaptive RT). ART aims to improve the accuracy and effectiveness of radiation delivery while minimizing damage to surrounding healthy tissues. The purpose of the WP4 group is to support the development and implementation of adaptive radiotherapy in Denmark.  

We aim to:   

• Establish an overview of ongoing protocols/initiatives within the field and share the publications from these efforts.  

• Strengthen national collaborations.  

• Support the translation of research findings into clinical practice.  

• Evolve and standardize adaptive strategies across centers.    

Challenges and considerations:  

• Implementing ART often requires advanced technology and expertise,      leading to significant costs. Identifying subpopulations that will benefit most from this technique is essential.  

• The field constantly evolves, with new expensive equipment becoming available and outpacing the availability of supporting evidence.  

• The observed improvement in outcomes results from advancements across all steps in cancer care. From diagnosis and staging to systemic therapies, improved imaging quality, and new developments within the radiotherapy department. Therefore, the improvements we document will always be attributed to several advances within the field.  

Picture A: Standard non-adaptive RT

Picture B: Offline adaptive RT 

Picture C: Online adaptive RT 

Background

The WP 4 group was initially established as one of the work packages within the DCCC RT. Over time, it conducted numerous local and national projects testing adaptive techniques in radiation therapy. The group's activity gradually decreased as these techniques became increasingly integrated into clinics across Denmark. However, the rise in the use of motion management, hypofractionated treatment courses, and the investment in new technology (e.g., MR-linac, Ethos) has created a need to re-establish national cooperation on adaptive radiation therapy. 

At the last annual meeting in DCCC RT, the WP4 group (WP4—Adaptive Radiation Therapy) was constituted as a successor to the previous group. We aim to focus on the clinical and interdisciplinary aspects of adaptive radiation therapy while also helping to support and establish national projects. 

Projects

Below is an overview of active projects, initiatives and publications in Denmark within the focus area of the WP4 Group. Contact information is included for each project.  

Please feel free to contact one of the WP4 leaders if you have information’s you would like to add to the list. 

WP leaders

Laura Patricia Kaplan (Næstved), e-mail: lakap@regionsjaelland.dk 

Thomas Ravkilde (AUH), e-mail: thomas.ravkilde@rm.dk 

Mette van Overeem Felter (HGH), e-mail: mette.van.overeem.felter@regionh.dk