Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part II: Offline and online plan adaption for interfractional changes

Jenny Bertholet,Gail Anastasi,David Noble,Arjan Bel,Ruud Van Leeuwen,Toon Roggen,Michael Duchateau,Sara Pilskog,Cristina Garibaldi,Nina Tilly,Rafael García-Mollá,Jorge Bonaque,Uwe Oelfke,Marianne C Aznar,Ben Heijmen

doi:10.1016/j.radonc.2020.06.017

Abstract

PurposeThe POP-ART RT study aims to determine to what extent and how intrafractional real-time respiratory motion management (RRMM), and plan adaptation for interfractional anatomical changes (ART) are used in clinical practice and to understand barriers to implementation. Here we report on part II: ART using more than one plan per target per treatment course. Materials and methodsA questionnaire on the current practice of ART, wishes for expansion or implementation, and barriers to implementation was distributed worldwide. Four types of ART were discriminated: daily online replanning, online plan library, protocolled offline replanning (all three based on a protocol), and ad-hoc offline replanning. ResultsThe questionnaire was completed by 177 centres from 40 countries. ART was used by 61% of respondents (31% with protocol) for a median (range) of 3 (1–8) tumour sites. CBCT/MVCT was the main imaging modality except for online daily replanning (11 users) where 10 users used MR. Two thirds of respondents wished to implement ART for a new tumour site; 40% of these had plans to do it in the next 2 years. Human/material resources and technical limitations were the main barriers to further use and implementation. ConclusionsART was used for a broad range of tumour sites, mainly with ad-hoc offline replanning and for a median of 3 tumour sites. There was a large interest in implementing ART for more tumour sites, mainly limited by human/material resources and technical limitations. Daily online replanning was primarily performed on MR-linacs.

Highlights

The POP-Adaptive RT (ART) Radiation therapy (RT) study aims to determine to what extent and how intrafractional real-time respiratory motion management (RRMM), and plan adaptation for interfractional anatomical changes (ART) are used in clinical practice and to understand barriers to implementation
The ART questions were completed by 177 institutions from 40 countries (Table A.1)
In addition to the tumour sites explicitly mentioned in the questionnaire and indicated in Table 1, four respondents used ART for sarcoma, two for anal canal, two for oesophagus, two for lymphoma, one for oligometastatic lymph nodes, one for cranial SRS and one respondent for liver, pancreas and abdomino-pelvic metastases

Summary

Introduction

The POP-ART RT study aims to determine to what extent and how intrafractional real-time respiratory motion management (RRMM), and plan adaptation for interfractional anatomical changes (ART) are used in clinical practice and to understand barriers to implementation. We report on part II: ART using more than one plan per target per treatment course. Two thirds of respondents wished to implement ART for a new tumour site; 40% of these had plans to do it in the 2 years. There was a large interest in implementing ART for more tumour sites, mainly limited by human/material resources and technical limitations. Several tumour sites present important anatomical variations during the course of treatment, which can happen on various time-scales from. Depending on the approach and tumour site, the need for a change in treatment plan is derived from offline or in-room (online) imaging [5,6]

Methods

Results

Conclusion