Adaptive Radiation Therapy
The purpose of the WP4 group is to support the development and implementation of adaptive radiotherapy in Denmark.
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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
RESEARCH PROJECT |
DESCRIPTION |
CENTER |
CONTACT INFORMATION |
RAPID-CARE |
CBCT-based online adaptive radiotherapy in palliative patients with bone metastasis |
Vejle |
|
National Phase II study of proton therapy for HCC |
Respiratory gated proton therapy for HCC |
DCPT |
esbeworm@rm.dk, Hanna.Mortensen@auh.rm.dk, britta.weber@auh.rm.dk
|
Gated liver SBRT |
Respiratory gated liver SBRT with triggered imaging. |
AUH |
|
Intra-fraction motion - Lung |
Intra-fraktionel bevægelse på SBRT-lung-tumorer grundet gravity-effect |
Aalborg |
m.brincker@rn.dk |
ROAR-Aa |
On-line adaption in analcancer on ETHOS |
HGH |
|
ROAR-Bb |
On-line adaption in bladder cancer on ETHOS |
HGH |
|
STAR-Lungc |
On-line adaption of lung tumors |
RH/HGH/OUH |
|
SØJLENd |
Accelerated diagnostic and therapeutic workflow for MSCC. |
HGH |
|
DIBH Lunge |
Lung-SBRT intrafraction motion |
HGH |
|
SOFTf |
MR-guided RT of SOFT tissue metastases |
HGH, RH, OUH |
|
MWA vs. SBRT |
RCT for livermetastases |
RH, HGH |
signe.lenora.risumlund@regionh.dk |
DoseTracker |
Real-time motion-including dose reconstruction |
AUH |
|
INITIATIVES |
DESCRIPTION |
CENTER |
CONTACT INFORMATION |
WP4 Retreat meeting |
Planning of retreat-meeting in the WP4 group |
AUH, Næstved, HGH |
|
WP4 National survey |
Conducting a national survey of the use of adaption at the centers in DK |
All |
-
Rune Slot Thing
Hospitalsfysiker, ph.d.
Sygehus Lillebælt, Vejle Sygehus -
Esben Schjødt Worm
Medical Physicist, PhD
Aarhus University Hospital -
Claus F. Behrens
Ph.D.
Herlev Hospital -
Katrin Håkansson
MSc, PhD
Rigshospitalet, Copenhagen -
Mirjana Josipovic
Hospitalsfysiker, PhD
Rigshospitalet, Copenhagen -
Thomas Ravkilde
Hospitalsfysiker, MSc, PhD
Aarhus University Hospital -
Uffe Bernchou
Lektor i Medicinsk Fysik
Odense University Hospital -
Lone Hoffmann
PhD, clinical associate professor
Aarhus University Hospital -
Ivan R. Vogelius
Head of Medical Physics, Professor
Rigshospitalet, Copenhagen -
Gitte Persson
MD, PhD, Associate Professor
Herlev Hospital -
Ditte Sloth Møller
Head of Medical Physics, PhD
Aarhus University Hospital -
Laura Patricia Kaplan
Physicist, PhD
Zealand University Hospital, Næstved Sygehus -
Mette van Overeem Felter
MD, PhD
Herlev Hospital