{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:40:35Z","timestamp":1791434435278,"version":"4.3.3"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T00:00:00Z","timestamp":1730764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T00:00:00Z","timestamp":1730764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Herzzentrum G\u00f6ttingen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Conventional image-guided radiotherapy (IGRT) of the prostate bed is challenged by the varying anatomy due to dynamic changes of surrounding organs such as the bladder and rectum. This leads to changed dose coverage of target and surrounding tissue. The novel online adaptive radiotherapy (oART) aims to improve target coverage as well as reduce dose exposure to surrounding healthy tissues by daily reoptimization of treatment plans. Here we set out to quantify the resulting changes of this adaptation for patients and treatment team.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A\u00a0total of 198 fractions of radiotherapy of the prostate bed (6\u00a0patients) were treated using oART with the Ethos accelerator (Varian Medical Systems, Palo Alto, CA, USA). For each fraction, volumes and several dose\u2013volume parameters of target volumes and organs at risk were recorded for the scheduled plan (initial plan, recalculated based on daily cone beam computed tomography [CBCT]), the adapted plan, and the verification plan, which is the dose distribution of the applied plan recalculated on the closing CBCT after the adaptation process. Clinical acceptability for all plans was determined using given dose\u2013volume parameters of target volumes. Additionally, the time needed for the adaptation process was registered and compared to the time required for the daily treatment of five conventional IGRT patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Volumes of target and organs at risk (OAR) exhibited broad variation from day to day. The differences in dose coverage D\n                      <jats:sub>98%<\/jats:sub>\n                      of the clinical target volume (CTV) were significant through adaptation (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.0001; median D\n                      <jats:sub>98%<\/jats:sub>\n                      97.1\u201398.0%) and further after verification CBCT (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001; median D\n                      <jats:sub>98%<\/jats:sub>\n                      98.1%). Similarly, differences in D\n                      <jats:sub>98%<\/jats:sub>\n                      of the planning target volume (PTV) were significant with adaptation (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.0001; median D\n                      <jats:sub>98%<\/jats:sub>\n                      91.8\u201396.5%) and after verification CBCT (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001; median D\n                      <jats:sub>98%<\/jats:sub>\n                      96.4%) with decreasing interquartile ranges (IQR). Dose to OAR varied extensively and did not show a\u00a0consistent benefit from oART but decreased in IQR. Clinical acceptability increased significantly from 19.2% for scheduled plans to 76.8% for adapted plans and decreased to 70.7% for verification plans. The scheduled plan was never chosen for treatment. The median time needed for oART was 25\u202fmin compared to 8\u202fmin for IGRT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Target dose coverage was significantly improved using oART. IQR decreased for target coverage as well as OAR doses indicating higher repeatability of dose delivery using oART. Differences in doses after verification CBCT for targets as well as OAR were significant compared to adapted plans but did not offset the overall dosimetric gain of oART. The median time required is three times higher for oART compared to IGRT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-024-02323-6","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T08:02:00Z","timestamp":1730793720000},"page":"767-778","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["CBCT-based online adaptive radiotherapy of the prostate bed: first clinical experience and comparison to nonadaptive conventional IGRT"],"prefix":"10.1007","volume":"201","author":[{"given":"J.","family":"Fischer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. A.","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Bensberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Bojko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Bouabdallaoui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Frohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"H\u00fcttenrauch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Tegeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Wenzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Guhlich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Leu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"El Shafie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Stamm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.-F.","family":"Schilling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. H.","family":"Dr\u00f6ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Rieken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,5]]},"reference":[{"key":"2323_CR1","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1088\/0031-9155\/42\/1\/008","volume":"42","author":"D Yan","year":"1997","unstructured":"Yan\u00a0D, Vicini\u00a0F, Wong\u00a0J, Martinez\u00a0A (1997) Adaptive radiation therapy. Phys Med Biol 42:123. https:\/\/doi.org\/10.1088\/0031-9155\/42\/1\/008","journal-title":"Phys Med Biol"},{"key":"2323_CR2","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.rpor.2018.05.002","volume":"23","author":"I R\u00edos","year":"2018","unstructured":"R\u00edos\u00a0I, V\u00e1squez\u00a0I, Cuervo\u00a0E et\u00a0al (2018) Problems and solutions in IGRT for cervical cancer. Rep Pract Oncol Radiother 23:517\u2013527. https:\/\/doi.org\/10.1016\/j.rpor.2018.05.002","journal-title":"Rep Pract Oncol Radiother"},{"key":"2323_CR3","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/S0360-3016(00)00518-6","volume":"47","author":"M van Herk","year":"2000","unstructured":"van Herk\u00a0M, Remeijer\u00a0P, Rasch\u00a0C, Lebesque\u00a0JV (2000) The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys 47:1121\u20131135. https:\/\/doi.org\/10.1016\/S0360-3016(00)00518-6","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2323_CR4","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1259\/bjr.74.879.740294","volume":"74","author":"SL Morgan-Fletcher","year":"2001","unstructured":"Morgan-Fletcher\u00a0SL (2001) Prescribing, recording and reporting photon beam therapy (supplement to ICRU report\u00a050), ICRU report 62. ICRU, pp. ix+52, 1999 (ICRU Bethesda, MD) ISBN 0\u2011913394-61\u20110. Br J Radiol 74:294\u2013294. https:\/\/doi.org\/10.1259\/bjr.74.879.740294","journal-title":"Br J Radiol"},{"key":"2323_CR5","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.semradonc.2019.02.007","volume":"29","author":"J-J Sonke","year":"2019","unstructured":"Sonke\u00a0J\u2011J, Aznar\u00a0M, Rasch\u00a0C (2019) Adaptive radiotherapy for anatomical changes. Semin Radiat Oncol 29:245\u2013257. https:\/\/doi.org\/10.1016\/j.semradonc.2019.02.007","journal-title":"Semin Radiat Oncol"},{"key":"2323_CR6","doi-asserted-by":"publisher","first-page":"e230011","DOI":"10.1148\/rycan.230011","volume":"5","author":"E Lavrova","year":"2023","unstructured":"Lavrova\u00a0E, Garrett\u00a0MD, Wang\u00a0Y\u2011F et\u00a0al (2023) Adaptive radiation therapy: a\u00a0review of CT-based techniques. Radiol Imaging Cancer 5:e230011. https:\/\/doi.org\/10.1148\/rycan.230011","journal-title":"Radiol Imaging Cancer"},{"key":"2323_CR7","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.semradonc.2019.02.011","volume":"29","author":"KK Brock","year":"2019","unstructured":"Brock\u00a0KK (2019) Adaptive radiotherapy: moving into the future. Semin Radiat Oncol 29:181\u2013184. https:\/\/doi.org\/10.1016\/j.semradonc.2019.02.011","journal-title":"Semin Radiat Oncol"},{"key":"2323_CR8","doi-asserted-by":"publisher","first-page":"10TR01","DOI":"10.1088\/1361-6560\/accdb2","volume":"68","author":"Z Qiu","year":"2023","unstructured":"Qiu\u00a0Z, Olberg\u00a0S, Den Hertog\u00a0D et\u00a0al (2023) Online adaptive planning methods for intensity-modulated radiotherapy. Phys Med Biol 68:10TR01. https:\/\/doi.org\/10.1088\/1361-6560\/accdb2","journal-title":"Phys Med Biol"},{"key":"2323_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/0284186X.2023.2257377","volume":"0","author":"ME Bak","year":"2023","unstructured":"Bak\u00a0ME, Jensen\u00a0NKG, N\u00f8ttrup\u00a0TJ et\u00a0al (2023) Clinical experiences with online adaptive radiotherapy of vulvar carcinoma. Acta Oncol 0:1\u20139. https:\/\/doi.org\/10.1080\/0284186X.2023.2257377","journal-title":"Acta Oncol"},{"key":"2323_CR10","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s00066-023-02125-2","volume":"200","author":"J Berchtold","year":"2024","unstructured":"Berchtold\u00a0J, Winkler\u00a0C, Karner\u00a0J et\u00a0al (2024) Noninvasive inter- and intrafractional motion control in ultrahypofractionated radiation therapy of prostate cancer using RayPilot HypoCathTM\u2014a substitute for gold fiducial-based IGRT? Strahlenther Onkol 200:195\u2013201. https:\/\/doi.org\/10.1007\/s00066-023-02125-2","journal-title":"Strahlenther Onkol"},{"key":"2323_CR11","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1007\/s00066-017-1141-x","volume":"193","author":"P Wust","year":"2017","unstructured":"Wust\u00a0P, Joswig\u00a0M, Graf\u00a0R et\u00a0al (2017) Dosimetric implications of inter- and intrafractional prostate positioning errors during tomotherapy : comparison of gold marker-based registrations with native MVCT. Strahlenther Onkol 193:700\u2013706. https:\/\/doi.org\/10.1007\/s00066-017-1141-x","journal-title":"Strahlenther Onkol"},{"key":"2323_CR12","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.tipsro.2022.02.002","volume":"21","author":"GA Smith","year":"2022","unstructured":"Smith\u00a0GA, Dunlop\u00a0A, Barnes\u00a0H et\u00a0al (2022) Bladder filling in patients undergoing prostate radiotherapy on a\u00a0MR-linac: The dosimetric impact. Tech Innov Patient Support Radiat Oncol 21:41\u201345. https:\/\/doi.org\/10.1016\/j.tipsro.2022.02.002","journal-title":"Tech Innov Patient Support Radiat Oncol"},{"key":"2323_CR13","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1016\/j.ijrobp.2023.10.015","volume":"118","author":"BK Neilsen","year":"2024","unstructured":"Neilsen\u00a0BK, Ma\u00a0TM, Akingbemi\u00a0WO et\u00a0al (2024) Impact of interfractional bladder and trigone displacement and deformation on radiation exposure and subsequent acute genitourinary toxicity: a\u00a0post hoc analysis of patients treated with magnetic resonance imaging-guided prostate stereotactic body radiation therapy in a\u00a0phase\u00a03 randomized trial. Int J Radiat Oncol Biol Phys 118:986\u2013997. https:\/\/doi.org\/10.1016\/j.ijrobp.2023.10.015","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2323_CR14","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s11255-023-03814-8","volume":"56","author":"D Yalman","year":"2024","unstructured":"Yalman\u00a0D, K\u00f6yl\u00fc\u00a0M, Duran \u00d6 (2024) Does a\u00a0patient-specific bladder-filling protocol affect bladder volume and dose in postprostatectomy radiotherapy? Int Urol Nephrol 56:999\u20131006. https:\/\/doi.org\/10.1007\/s11255-023-03814-8","journal-title":"Int Urol Nephrol"},{"key":"2323_CR15","doi-asserted-by":"publisher","first-page":"3269","DOI":"10.1007\/s00432-021-03739-8","volume":"147","author":"F Cuccia","year":"2021","unstructured":"Cuccia\u00a0F, Rigo\u00a0M, Gurrera\u00a0D et\u00a0al (2021) Mitigation on bowel loops daily variations by 1.5\u2011T MR-guided daily-adaptive SBRT for abdomino-pelvic lymph-nodal oligometastases. J\u00a0Cancer Res Clin Oncol 147:3269\u20133277. https:\/\/doi.org\/10.1007\/s00432-021-03739-8","journal-title":"J Cancer Res Clin Oncol"},{"key":"2323_CR16","doi-asserted-by":"publisher","first-page":"100693","DOI":"10.1016\/j.ctro.2023.100693","volume":"44","author":"M Waters","year":"2023","unstructured":"Waters\u00a0M, Price\u00a0A, Laugeman\u00a0E et\u00a0al (2023) CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer. Clin Transl Radiat Oncol 44:100693. https:\/\/doi.org\/10.1016\/j.ctro.2023.100693","journal-title":"Clin Transl Radiat Oncol"},{"key":"2323_CR17","doi-asserted-by":"publisher","first-page":"e345","DOI":"10.1016\/j.prro.2022.11.003","volume":"13","author":"HE Morgan","year":"2023","unstructured":"Morgan\u00a0HE, Wang\u00a0K, Yan\u00a0Y et\u00a0al (2023) Preliminary evaluation of PTV margins for online adaptive radiation therapy of the prostatic fossa. Pract Radiat Oncol 13:e345\u2013e353. https:\/\/doi.org\/10.1016\/j.prro.2022.11.003","journal-title":"Pract Radiat Oncol"},{"key":"2323_CR18","doi-asserted-by":"publisher","first-page":"e13479","DOI":"10.1002\/acm2.13479","volume":"23","author":"M Byrne","year":"2022","unstructured":"Byrne\u00a0M, Archibald-Heeren\u00a0B, Hu\u00a0Y et\u00a0al (2022) Varian ethos online adaptive radiotherapy for prostate cancer: early results of contouring accuracy, treatment plan quality, and treatment time. J\u00a0Appl Clin Med Phys 23:e13479. https:\/\/doi.org\/10.1002\/acm2.13479","journal-title":"J Appl Clin Med Phys"},{"key":"2323_CR19","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.phro.2019.02.002","volume":"9","author":"SU Tetar","year":"2019","unstructured":"Tetar\u00a0SU, Bruynzeel\u00a0AME, Lagerwaard\u00a0FJ et\u00a0al (2019) Clinical implementation of magnetic resonance imaging guided adaptive radiotherapy for localized prostate cancer. Phys Imaging Radiat Oncol 9:69\u201376. https:\/\/doi.org\/10.1016\/j.phro.2019.02.002","journal-title":"Phys Imaging Radiat Oncol"},{"key":"2323_CR20","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1080\/0284186X.2019.1627417","volume":"58","author":"AS Bertelsen","year":"2019","unstructured":"Bertelsen\u00a0AS, Schytte\u00a0T, M\u00f8ller\u00a0PK et\u00a0al (2019) First clinical experiences with a\u00a0high field 1.5 T MR linac. Acta Oncol 58:1352\u20131357. https:\/\/doi.org\/10.1080\/0284186X.2019.1627417","journal-title":"Acta Oncol"},{"key":"2323_CR21","doi-asserted-by":"publisher","first-page":"e13961","DOI":"10.1002\/acm2.13961","volume":"24","author":"DN Stanley","year":"2023","unstructured":"Stanley\u00a0DN, Harms\u00a0J, Pogue\u00a0JA et\u00a0al (2023) A roadmap for implementation of kV-CBCT online adaptive radiation therapy and initial first year experiences. J\u00a0Appl Clin Med Phys 24:e13961. https:\/\/doi.org\/10.1002\/acm2.13961","journal-title":"J Appl Clin Med Phys"},{"key":"2323_CR22","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1007\/s00066-022-02005-1","volume":"199","author":"Y Xiong","year":"2023","unstructured":"Xiong\u00a0Y, Rabe\u00a0M, Nierer\u00a0L et\u00a0al (2023) Assessment of intrafractional prostate motion and its dosimetric impact in MRI-guided online adaptive radiotherapy with gating. Strahlenther Onkol 199:544\u2013553. https:\/\/doi.org\/10.1007\/s00066-022-02005-1","journal-title":"Strahlenther Onkol"},{"key":"2323_CR23","doi-asserted-by":"publisher","first-page":"101405","DOI":"10.1016\/j.adro.2023.101405","volume":"9","author":"M Byrne","year":"2024","unstructured":"Byrne\u00a0M, Teh\u00a0AYM, Archibald-Heeren\u00a0B et\u00a0al (2024) Intrafraction motion and margin assessment for ethos online adaptive radiotherapy treatments of the prostate and seminal vesicles. Adv Radiat Oncol 9:101405. https:\/\/doi.org\/10.1016\/j.adro.2023.101405","journal-title":"Adv Radiat Oncol"}],"container-title":["Strahlentherapie und Onkologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-024-02323-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00066-024-02323-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-024-02323-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T11:22:42Z","timestamp":1753183362000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00066-024-02323-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,5]]},"references-count":23,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["2323"],"URL":"https:\/\/doi.org\/10.1007\/s00066-024-02323-6","relation":{},"ISSN":["0179-7158","1439-099X"],"issn-type":[{"value":"0179-7158","type":"print"},{"value":"1439-099X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,5]]},"assertion":[{"value":"29 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"J.\u00a0Fischer, L.\u00a0A.\u00a0Fischer, J.\u00a0Bensberg, N.\u00a0Bojko, M.\u00a0Bouabdallaoui, J.\u00a0Frohn, P.\u00a0H\u00fcttenrauch, K.\u00a0Tegeler, D.\u00a0Wagner, A.\u00a0Wenzel, D.\u00a0Schmitt, M.\u00a0Guhlich, M.\u00a0Leu, R.\u00a0El Shafie, G.\u00a0Stamm, A.-F.\u00a0Schilling, L.\u00a0H.\u00a0Dr\u00f6ge and S.\u00a0Rieken declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}