Enhancing Adaptive Radiotherapy with Dynamic Prescription Modifications

Summary: This study aims to enhance adaptive radiotherapy through dynamic prescription modifications as with even adaptive radiotherapy there is a risk that targets can be under dosed. By evaluating the cumulative doses in the adaptive treatment management monitoring workspace, the prescription dose can be adjusted accordingly. This approach ensures that the treatment is precisely tailored to the patient’s evolving dose distribution throughout the typical treatment course. This is a retrospective study utilizing the adaptive treatment management monitoring workspace to review data from 12 patients treated using adaptive radiotherapy prescribed to a dose of 7000 cGy delivered in 28 fractions (Fx)(250 cGy/Fx). The delivered dose to the planning target volume (PTV) and organs at risk (OARs) were assessed at every fifth fraction to evaluate potential prescription modifications. Optimal coverage was for the PTV to V100% >= 95% of the prescription dose. For OARs, the tolerances were V4500 = 100% while safely maintaining the predefined constraint margins for the OARs. Leveraging accumulated dose for patients on-treatment is a quick check that can be used to maximize dose to PTV or reduce dose to OARs during radiation treatment. Our evaluation indicates the opportunity to adjust the dose every five fractions. With adaptive radiotherapy becoming increasingly streamlined, realizing this potential soon seems feasible. Phillip M. Jenkins, DO, MS (Presenting Author) - Detroit Medical Center/Wayne State University; Peter Whatts Ortiz, MD (Co-Author) - Detroit Medical Center/Wayne State University; Steven R. Miller, MD (Co-Author) - Detroit Medical Center/Wayne State Unive; Ramesh Boggula, PhD (Co-Author) - Wayne State University/Karmanos Cancer Institute