[Adaptive radiotherapy in routine use? State of the art: The medical physicist's point of view]

Abstract

The development of both image-guided and intensity-modulated radiotherapy has underlined the question of treatment adaptation to anatomical and/or biological changes occurring during radiotherapy course and modifying delivered dose to the patient. Adaptive radiotherapy has been introduced when several plans are used to treat a patient during radiotherapy. Adaptation may be performed online, offline or in a hybrid way. New images of the patient are needed for adaptive radiotherapy to perform many processes: image registration, segmentation and evaluation of cumulative dose. Deformable image registration methods are generally used to image registration and contours propagation. Fraction and cumulative dose evaluations use deformable image registration methods or more complex methods based on Monte-Carlo calculation. These methods have uncertainties and have to be evaluated. However, evaluation and validation tools are still being developed. The physicist's mission is to ensure that every new technology, such as adaptive radiotherapy, is deployed with highest safety, by technical validation and by implementing a specific quality assurance program. Adaptive radiotherapy implementation still raises many questions, so its potential clinical application requires great caution and should be carefully explored in prospective clinical trials.

Keywords: ART validation; Adaptive radiotherapy; Cumulative dose; Deformable image registration; Dose cumulée; IGRT; IMRT; Radiothérapie adaptative; Recalage d’image déformable; Validation.