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However, this study investigates the dosimetric impact of intra-adaptational anatomical changes that take place during the adaptation process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our retrospective analysis was conducted on 155 fractions from 8\u00a0prostate cancer patients treated with adaptive radiotherapy using the Varian Ethos system (Varian, Palo Alto, California, USA). Various dose\u2013volume metrics for the targets and organs at risk were assessed for (1)\u00a0the non-adapted (an original plan on a\u00a0pretreatment cone-beam CT [CBCT], acquired at the beginning of a\u00a0treatment session), (2)\u00a0the adapted (an adapted plan on a\u00a0pretreatment CBCT), and (3)\u00a0the delivered dose distributions (an adapted plan on a\u00a0pre-irradiation CBCT acquired for patient position verification with recontoured organs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For the target metrics, we quantitatively proved that the delivered dose distribution was still beneficial in comparison to the non-adapted one, despite the anatomical changes during the adaptation process. The bladder dose\u2013volume metrics strongly depended on the bladder volume variations across the planning CT and both CBCTs, frequently showing improvement during the adaptation process as the bladder continued to fill. In contrast, no clear trend was observed for the rectum or posterior rectum wall metrics. In only a\u00a0small fraction of sessions (up to 5% for most metrics) were the metric objectives not achieved with the delivered dose while they were achieved with the adapted one. Physiological reasons for these occurrences stemmed from meteorism occurring between pretreatment and pre-irradiation CBCTs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study confirms that the dosimetric advantages of online adaptive radiotherapy persist in clinical practice, despite anatomical changes due to the time delay needed for the adaptation process.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-025-02425-9","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T14:47:33Z","timestamp":1752590853000},"page":"1170-1184","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Intra-adaptational changes in online adaptive radiotherapy: from the ideal to the real dose"],"prefix":"10.1007","volume":"201","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1807-3430","authenticated-orcid":false,"given":"Hanna","family":"Malygina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Auerbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Nuesken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Salazar Zuniga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sobhan","family":"Moumeniahangar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Oeschger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Hecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Palm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Dzierma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"2425_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.phro.2020.12.004","volume":"17","author":"P Sibolt","year":"2021","unstructured":"Sibolt\u00a0P, Andersson\u00a0LM, Calmels\u00a0L, Sj\u00f6str\u00f6m\u00a0D, Bjelkengren\u00a0U, Geertsen\u00a0P, Behrens\u00a0CF (2021) Clinical implementation of artificial intelligence-driven cone-beam computed tomography-guided online adaptive radiotherapy in the pelvic region. 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Radiother Oncol. https:\/\/doi.org\/10.1016\/j.radonc.2022.109441","journal-title":"Radiother Oncol"}],"container-title":["Strahlentherapie und Onkologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-025-02425-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00066-025-02425-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-025-02425-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T17:41:17Z","timestamp":1761154877000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00066-025-02425-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":25,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["2425"],"URL":"https:\/\/doi.org\/10.1007\/s00066-025-02425-9","relation":{},"ISSN":["0179-7158","1439-099X"],"issn-type":[{"value":"0179-7158","type":"print"},{"value":"1439-099X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"assertion":[{"value":"17 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"J.\u00a0Palm and M. Hecht have received a\u00a0speaker honorarium from Varian Medical Systems, Inc. M. Hecht is a Varian Advisory Board member. H.\u00a0Malygina, H.\u00a0Auerbach, M.\u00a0Ries, F.\u00a0Nuesken, B.\u00a0Salazar Zuniga, S.\u00a0Moumeniahangar, F.\u00a0Oeschger and Y.\u00a0Dzierma declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. All patients provided written informed consent for the retrospective pseudonymized analysis of their data within the framework of the PRAIRIE trial protocol (ethics vote 111\/23 by the \u00c4rztekammer des Saarlandes).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}