{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:25:03Z","timestamp":1787653503837,"version":"build-2736575974"},"reference-count":116,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Online adaptive radiotherapy (oART) can change the dose distribution briefly to match the shape of the targets and organs at risk. Cone-beam computed tomography (CBCT)-guided oART has been introduced in clinical practice and is expected to improve clinical outcomes. This technology allows treatment as an extension of conventional CT-based image-guided radiotherapy technology and has the advantage of relatively short treatment times. However, the clinical and dosimetric benefits of oART have not yet been adequately reported. Methods: We systematically reviewed previous studies evaluating CBCT-guided oART in patients with malignancies. Case reports, conference abstracts, letters, editorials, and reviews were excluded. PubMed was searched from January 2019 to 22 November 2025, supplemented by hand searching. Study design, cancer site, workflow, treatment time, dosimetric outcomes, feasibility, and clinical outcomes were extracted. Owing to clinical and methodological heterogeneity, findings were synthesized narratively. Results: A total of 127 studies were included. Across most studies, adapted plans improved target coverage and reduced or maintained doses to organs at risk compared with scheduled plans. This review provides an overview of the workflows and latest developments in CBCT-guided oART. Furthermore, the clinical and dosimetric benefits at each site, including the chest, abdomen, pelvis, head, and neck, are shown. Conclusions: The development of oART is expected to lead to the introduction of personalized medicine and improve the clinical outcomes of patients with various cancers. Further research and clinical trials are warranted to establish CBCT-guided oART. This review received no external funding and was registered in PROSPERO (CRD420251237632).<\/jats:p>","DOI":"10.3390\/cancers18172755","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:04:55Z","timestamp":1787652295000},"page":"2755","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of CBCT-Guided Online Adaptive Radiotherapy"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2096-8847","authenticated-orcid":false,"given":"Katsuyuki","family":"Shirai","sequence":"first","affiliation":[{"name":"Department of Radiology, Jichi Medical University Hospital, Shimotsuke 329-0498, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5007-8808","authenticated-orcid":false,"given":"Noriko","family":"Kishi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1548-1970","authenticated-orcid":false,"given":"Hideaki","family":"Hirashima","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0798-8722","authenticated-orcid":false,"given":"Masashi","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jichi Medical University Hospital, Shimotsuke 329-0498, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7098-6221","authenticated-orcid":false,"given":"Rihito","family":"Aizawa","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4371-7288","authenticated-orcid":false,"given":"Masanori","family":"Takaki","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-Ku, Fukuoka 812-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadamasa","family":"Yoshitake","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-Ku, Fukuoka 812-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1933-9306","authenticated-orcid":false,"given":"Tomohiro","family":"Harasawa","sequence":"additional","affiliation":[{"name":"Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8544, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8725-869X","authenticated-orcid":false,"given":"Soichiro","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8544, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoosuk","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jichi Medical University Hospital, Shimotsuke 329-0498, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-8746","authenticated-orcid":false,"given":"Takashi","family":"Mizowaki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.radonc.2020.06.017","article-title":"Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part II: Offline and online plan adaption for interfractional changes","volume":"153","author":"Bertholet","year":"2020","journal-title":"Radiother. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13014-023-02221-8","article-title":"Clinical application of MR-Linac in tumor radiotherapy: A systematic review","volume":"18","author":"Liu","year":"2023","journal-title":"Radiat. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1533033818823054","DOI":"10.1177\/1533033818823054","article-title":"Evaluation and clinical application of a commercially available iterative reconstruction algorithm for CBCT-Based IGRT","volume":"18","author":"Mao","year":"2019","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.prro.2023.10.014","article-title":"Novel technology allowing cone beam computed tomography in 6 seconds: A patient study of comparative image quality","volume":"14","author":"Robar","year":"2024","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101874","DOI":"10.1016\/j.adro.2025.101874","article-title":"Optimizing workflow for cone beam computed tomography-based online adaptive radiation therapy toward reduced physician involvement","volume":"10","author":"Kalinauskaite","year":"2025","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e13961","DOI":"10.1002\/acm2.13961","article-title":"A roadmap for implementation of kV-CBCT online adaptive radiation therapy and initial first year experiences","volume":"24","author":"Stanley","year":"2023","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e14133","DOI":"10.1002\/acm2.14133","article-title":"Evaluation and correlation of patient movement during online adaptive radiotherapy with CBCT and a surface imaging system","volume":"24","author":"Stanley","year":"2023","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e13479","DOI":"10.1002\/acm2.13479","article-title":"Varian ethos online adaptive radiotherapy for prostate cancer: Early results of contouring accuracy, treatment plan quality, and treatment time","volume":"23","author":"Byrne","year":"2022","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e13783","DOI":"10.1002\/acm2.13783","article-title":"Dosimetric and feasibility evaluation of a CBCT-based daily adaptive radiotherapy protocol for locally advanced cervical cancer","volume":"24","author":"Branco","year":"2023","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e329","DOI":"10.1016\/j.prro.2021.12.017","article-title":"Evaluation of auto-contouring and dose distributions for online adaptive radiation therapy of patients with locally advanced lung cancers","volume":"12","author":"Mao","year":"2022","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"140","DOI":"10.4103\/jmp.jmp_188_24","article-title":"An end-to-end quality assurance procedure for ethos online adaptive radiotherapy","volume":"50","author":"Yoganathan","year":"2025","journal-title":"J. Med. Phys."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.ijrobp.2025.03.050","article-title":"Dosimetric advantages of online adaptive radiation therapy for head and neck squamous cell carcinoma: Results from a prospective registry study","volume":"122","author":"Shi","year":"2025","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_13","first-page":"100596","article-title":"Implementing cone-beam computed tomography-guided online adaptive radiotherapy in cervical cancer","volume":"40","author":"Shelley","year":"2023","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1016\/j.prro.2024.07.013","article-title":"Treatment time and dosimetric advantage in cone beam computed tomography-guided online adaptive radiation therapy considering interfractional and intrafractional changes in patients with gastric mucosa-associated lymphoid tissue lymphoma","volume":"15","author":"Uto","year":"2025","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e14337","DOI":"10.1002\/acm2.14337","article-title":"Image quality characterization of an ultra-high-speed kilovoltage cone-beam computed tomography imaging system on an O-ring linear accelerator","volume":"25","author":"Kim","year":"2024","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e14299","DOI":"10.1002\/acm2.14299","article-title":"ACR benchmark testing of a novel high-speed ring-gantry linac kV-CBCT system","volume":"25","author":"Haertter","year":"2024","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e70374","DOI":"10.1002\/acm2.70374","article-title":"Correlation between exposure (mAs) and image quality for a rapid cone-beam CT on a ring gantry linear accelerator","volume":"26","author":"Zhao","year":"2025","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"101681","DOI":"10.1016\/j.adro.2024.101681","article-title":"Comprehensive image quality evaluation and motion phantom studies of an ultra-fast (6-second) cone-beam computed tomography imaging system on a ring gantry linear accelerator","volume":"10","author":"Zhao","year":"2025","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"105018","DOI":"10.1088\/1361-6560\/ad3cb0","article-title":"Image quality evaluation of a new high-performance ring-gantry cone-beam computed tomography imager","volume":"69","author":"Lustermans","year":"2024","journal-title":"Phys. Med. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e14516","DOI":"10.1002\/acm2.14516","article-title":"Evaluation of a metal artifact reduction algorithm for image reconstruction on a novel CBCT platform","volume":"25","author":"Yashayaeva","year":"2024","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e70338","DOI":"10.1002\/acm2.70338","article-title":"HyperSight CBCT image quality and metal artifact reduction for adaptive head and neck radiotherapy: Results from a prospective clinical trial","volume":"26","author":"Yashayaeva","year":"2025","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"110458","DOI":"10.1016\/j.radonc.2024.110458","article-title":"The added value of a new high-performance ring-gantry CBCT imaging system for prostate cancer patients","volume":"200","author":"Kunnen","year":"2024","journal-title":"Radiother. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s13014-025-02730-8","article-title":"Advanced HyperSight imaging for patients with adaptive SBRT of prostate cancer: A longitudinal analysis of tissue demarcation","volume":"20","author":"Schmidt","year":"2025","journal-title":"Radiat. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e70130","DOI":"10.1002\/acm2.70130","article-title":"Localization accuracy of 6-second CBCT for lung IGRT with various breathing patterns","volume":"26","author":"Koo","year":"2025","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"7492","DOI":"10.1002\/mp.17325","article-title":"Technical note: Phantom-based evaluation of CBCT dose calculation accuracy for use in adaptive radiotherapy","volume":"51","author":"Wessels","year":"2024","journal-title":"Med. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e70245","DOI":"10.1002\/acm2.70245","article-title":"Feasibility of HyperSight CBCT for adaptive radiation therapy: A phantom benchmark study of dose calculation accuracy and delivery verification on the Halcyon","volume":"26","author":"Nelson","year":"2025","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"100756","DOI":"10.1016\/j.phro.2025.100756","article-title":"Dose calculation accuracy of clinical radiotherapy plans using next generation cone beam computed tomography imaging technology","volume":"34","author":"Martin","year":"2025","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"110596","DOI":"10.1016\/j.radonc.2024.110596","article-title":"Dose calculation accuracy of a new high-performance ring-gantry CBCT imaging system for prostate and lung cancer patients","volume":"202","author":"Sijtsema","year":"2025","journal-title":"Radiother. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"105091","DOI":"10.1016\/j.ejmp.2025.105091","article-title":"Evaluation of the dosimetric accuracy of HyperSight CBCT for CBCT-only adaptive radiotherapy workflow","volume":"137","author":"Dusi","year":"2025","journal-title":"Phys. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e70038","DOI":"10.1002\/acm2.70038","article-title":"Assessing HyperSight iterative CBCT for dose calculation in online adaptive radiotherapy for pelvis and breast patients compared to synthetic CT","volume":"26","author":"Duan","year":"2025","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"15863","DOI":"10.1038\/s41598-025-99920-x","article-title":"Longitudinal stability of HyperSight-CBCT based radiomic features in patients with CT guided adaptive SBRT for prostate cancer","volume":"15","author":"Cvachovec","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e70244","DOI":"10.1002\/acm2.70244","article-title":"Assessing dosimetric benefit from daily online adaptive radiation therapy for esophageal cancer","volume":"26","author":"Kubiatowicz","year":"2025","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"101656","DOI":"10.1016\/j.adro.2024.101656","article-title":"Cone beam computed tomography-based online adaptive radiation therapy of esophageal cancer: First clinical experience and dosimetric benefits","volume":"10","author":"Bachmann","year":"2024","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"110981","DOI":"10.1016\/j.radonc.2025.110981","article-title":"Cone-beam computed tomography-based online adaptive radiotherapy of esophageal cancer in the neoadjuvant setting: Dosimetric analysis, toxicity and treatment response","volume":"209","author":"Bachmann","year":"2025","journal-title":"Radiother. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Galand, A., Prunaretty, J., Mir, N., Morel, A., Bourgier, C., Aill\u00e8res, N., Azria, D., and Fenoglietto, P. (2023). Feasibility study of adaptive radiotherapy with Ethos for breast cancer. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1274082"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101414","DOI":"10.1016\/j.adro.2023.101414","article-title":"Improved dosimetry and plan quality for accelerated partial breast irradiation using online adaptive radiation therapy: A single institutional study","volume":"9","author":"Pogue","year":"2023","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.clbc.2025.08.018","article-title":"CBCT-guided online adaptive radiation therapy for accelerated partial breast irradiation: A single-institution experience","volume":"26","author":"Warden","year":"2026","journal-title":"Clin. Breast Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.ijrobp.2025.03.055","article-title":"Feasibility and impact of a radiation therapy technologist-driven workflow for cone beam computed tomography guided partial breast adaptive radiation therapy","volume":"122","author":"Parsons","year":"2025","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"101664","DOI":"10.1016\/j.adro.2024.101664","article-title":"Clinical implementation of cone beam computed tomography-guided online adaptive radiation therapy in whole breast irradiation","volume":"10","author":"Nelissen","year":"2024","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101226","DOI":"10.1016\/j.adro.2023.101226","article-title":"Prospective in silico evaluation of cone-beam computed tomography-guided stereotactic adaptive radiation therapy (CT-STAR) for the ablative treatment of ultracentral thoracic disease","volume":"8","author":"Schiff","year":"2023","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13014-024-02427-4","article-title":"Protocol of a phase II study to evaluate the efficacy and safety of deep-inspiration breath-hold daily online adaptive radiotherapy for centrally located lung tumours (PUDDING study)","volume":"19","author":"Kishi","year":"2024","journal-title":"Radiat. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13014-023-02222-7","article-title":"Dosimetric benefits of adaptive radiation therapy for patients with stage III non-small cell lung cancer","volume":"18","author":"Hoppen","year":"2023","journal-title":"Radiat. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"101740","DOI":"10.1016\/j.adro.2025.101740","article-title":"Assessing dosimetric benefits of cone beam computed tomography-guided online adaptive radiation treatment frequencies for lung cancer","volume":"10","author":"Duan","year":"2025","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e395","DOI":"10.1016\/j.prro.2024.02.007","article-title":"Adapt-on-demand: A novel strategy for personalized adaptive radiation therapy for locally advanced lung cancer","volume":"14","author":"Li","year":"2024","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.ijrobp.2025.03.061","article-title":"Computed tomography-guided online adaptive stereotactic body radiation therapy for liver tumors: A retrospective study","volume":"122","author":"Lukez","year":"2025","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"095015","DOI":"10.1088\/1361-6560\/ad39a1","article-title":"Markerless liver online adaptive stereotactic radiotherapy: Feasibility analysis","volume":"69","author":"Pierrard","year":"2024","journal-title":"Phys. Med. Biol."},{"key":"ref_47","first-page":"100813","article-title":"CT-guided online adaptive stereotactic body radiotherapy for pancreas ductal adenocarcinoma: Dosimetric and initial clinical experience","volume":"48","author":"Lee","year":"2024","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"22101","DOI":"10.1038\/s41598-024-72831-z","article-title":"Online adaptive radiotherapy in stereotactic body radiotherapy for pancreatic cancer patients","volume":"14","author":"Jiang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e13827","DOI":"10.1002\/acm2.13827","article-title":"Potential utility of cone-beam CT-guided adaptive radiotherapy under end-exhalation breath-hold conditions for pancreatic cancer","volume":"24","author":"Ogawa","year":"2023","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"101164","DOI":"10.1016\/j.adro.2022.101164","article-title":"Dose escalation for pancreas SBRT: Potential and limitations of using daily online adaptive radiation therapy and an iterative isotoxicity automated planning approach","volume":"8","author":"Rhee","year":"2023","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"100321","DOI":"10.1016\/j.tipsro.2025.100321","article-title":"Dosimetric evaluation of cone beam computed tomography-guided online adaptive radiotherapy in gastric mucosa-associated lymphoid tissue lymphoma","volume":"35","author":"Takaki","year":"2025","journal-title":"Tech. Innov. Patient Support Radiat. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1093\/jrr\/rrae052","article-title":"Evaluation of PTV margin in CBCT-based online adaptive radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma","volume":"65","author":"Hirose","year":"2024","journal-title":"J. Radiat. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e621","DOI":"10.1016\/j.prro.2025.05.008","article-title":"Can online adaptive radiation therapy eliminate intrafractional deformation in gastric mucosa-associated lymphoid tissue lymphoma?","volume":"15","author":"Shibayama","year":"2025","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.ijrobp.2022.06.078","article-title":"In silico trial of computed tomography-guided stereotactic adaptive radiation therapy (CT-STAR) for the treatment of abdominal oligometastases","volume":"114","author":"Schiff","year":"2022","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.ijrobp.2025.03.036","article-title":"Reducing number of treatment fractions for patients with abdominal lymph node oligometastases: The need for online adaptive radiation therapy to provide personalized adaptive fractionation","volume":"122","author":"Hoogeman","year":"2025","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Wurschi, G., Voigt, A., Murr, N., Riede, C., Schwedas, M., Romer, M., Drozdz, S., and Pietschmann, K. (2025). CBCT-based online adaptive, ultra-hypofractionated radiotherapy for prostate cancer: First clinical experiences. Medicina, 61.","DOI":"10.3390\/medicina61101839"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"111207","DOI":"10.1016\/j.radonc.2025.111207","article-title":"CT online adaptive radiotherapy is associated with dosimetric and acute toxicity improvements in prostate cancer treatment","volume":"213","author":"Zhu","year":"2025","journal-title":"Radiother. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Khouya, A., Pottgen, C., Hoffmann, C., Ringbaek, T.P., Lubcke, W., Indenkampen, F., Guberina, M., Guberina, N., Gauler, T., and Stuschke, M. (2023). Adaptation Time as a Determinant of the dosimetric effectiveness of online adaptive radiotherapy for bladder cancer. Cancers, 15.","DOI":"10.3390\/cancers15235629"},{"key":"ref_59","first-page":"100693","article-title":"CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer","volume":"44","author":"Waters","year":"2024","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Pottgen, C., Hoffmann, C., Gauler, T., Guberina, M., Guberina, N., Ringbaek, T., Santiago Garcia, A., Krafft, U., Hadaschik, B., and Khouya, A. (2023). Fractionation versus adaptation for compensation of target volume changes during online adaptive radiotherapy for bladder cancer: Answers from a prospective registry. Cancers, 15.","DOI":"10.3390\/cancers15204933"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1509619","DOI":"10.3389\/fonc.2025.1509619","article-title":"Evaluating the implementation of fan-beam CT-guided online adaptive re-planning in definitive cervical cancer radiotherapy","volume":"15","author":"Sun","year":"2025","journal-title":"Front Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/j.ijrobp.2025.03.051","article-title":"A prospective single-arm study of daily online adaptive radiation therapy for cervical cancer with reduced planning target volume margin: Acute toxicity and dosimetric outcomes","volume":"122","author":"Wang","year":"2025","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Jiang, D., Yang, C., Sun, S., Wang, D., Xiao, Z., Hu, J., Mei, Z., Xie, C., Liu, H., and Qiu, H. (2024). First implementation and results of online adaptive radiotherapy for cervical cancer based on CT-Linac combination. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1399468"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"101510","DOI":"10.1016\/j.adro.2024.101510","article-title":"Daily online adaptive radiation therapy of postoperative endometrial and cervical cancer with PTV margin reduction to 5 mm: Dosimetric outcomes, acute toxicity, and first clinical experience","volume":"9","author":"Wang","year":"2024","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13014-023-02394-2","article-title":"Evaluation of PTV margins with daily iterative online adaptive radiotherapy for postoperative treatment of endometrial and cervical cancer: A prospective single-arm phase 2 study","volume":"19","author":"Wang","year":"2024","journal-title":"Radiat. Oncol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1080\/0284186X.2023.2257377","article-title":"Clinical experiences with online adaptive radiotherapy of vulvar carcinoma","volume":"62","author":"Bak","year":"2023","journal-title":"Acta. Oncol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e234066","DOI":"10.1001\/jamanetworkopen.2023.4066","article-title":"Comparison of online-onboard adaptive intensity-modulated radiation therapy or volumetric-modulated arc radiotherapy with image-guided radiotherapy for patients with gynecologic tumors in dependence on fractionation and the planning target volume margin","volume":"6","author":"Guberina","year":"2023","journal-title":"JAMA. Netw. Open"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Malygina, H., Salazar Zuniga, B., Auerbach, H., Ries, M., Dzierma, Y., Hecht, M., and Palm, J. (2025). Daily online adaptation enhances target coverage in prostate cancer radiotherapy: A retrospective analysis. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1662671"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1002\/pro6.70013","article-title":"Evaluating intra-fraction motion and its dosimetric impact in ethos online adaptive radiotherapy for prostate cancer","volume":"9","author":"Sa","year":"2025","journal-title":"Precis Radiat. Oncol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s13014-025-02697-6","article-title":"AI-driven online adaptive radiotherapy in prostate cancer treatment: Considerations on activity time and dosimetric benefits","volume":"20","author":"Preziosi","year":"2025","journal-title":"Radiat. Oncol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1007\/s00066-025-02425-9","article-title":"Intra-adaptational changes in online adaptive radiotherapy: From the ideal to the real dose","volume":"201","author":"Malygina","year":"2025","journal-title":"Strahlenther. Onkol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s00066-024-02323-6","article-title":"CBCT-based online adaptive radiotherapy of the prostate bed: First clinical experience and comparison to nonadaptive conventional IGRT","volume":"201","author":"Fischer","year":"2025","journal-title":"Strahlenther. Onkol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"101405","DOI":"10.1016\/j.adro.2023.101405","article-title":"Intrafraction motion and margin assessment for Ethos online adaptive radiotherapy treatments of the prostate and seminal vesicles","volume":"9","author":"Byrne","year":"2024","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1080\/0284186X.2023.2252584","article-title":"Reduction of PTV margins for elective pelvic lymph nodes in online adaptive radiotherapy of prostate cancer patients","volume":"62","author":"Brennsaeter","year":"2023","journal-title":"Acta Oncol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.phro.2022.04.009","article-title":"Cone-beam computed tomography-guided online adaptive radiotherapy is feasible for prostate cancer patients","volume":"22","author":"Zwart","year":"2022","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e345","DOI":"10.1016\/j.prro.2022.11.003","article-title":"Preliminary evaluation of PTV margins for online adaptive radiation therapy of the prostatic fossa","volume":"13","author":"Morgan","year":"2023","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.ijrobp.2007.11.054","article-title":"Observations on real-time prostate gland motion using electromagnetic tracking","volume":"71","author":"Langen","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s13014-025-02710-y","article-title":"CBCT-based online adaptive radiotherapy of the bladder\u2014Geometrical and dosimetrical considerations compared to conventional IGRT","volume":"20","author":"Fischer","year":"2025","journal-title":"Radiat. Oncol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1007\/s00066-025-02397-w","article-title":"Reduction of the planning target volume with daily online adaptive radiotherapy in bladder cancer","volume":"201","author":"Varga","year":"2025","journal-title":"Strahlenther. Onkol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1186\/s13014-023-02348-8","article-title":"Online adaptive radiotherapy for bladder cancer using a simultaneous integrated boost and fiducial markers","volume":"18","author":"Azzarouali","year":"2023","journal-title":"Radiat. Oncol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.radonc.2022.03.014","article-title":"Online adaptive radiotherapy of urinary bladder cancer with full re-optimization to the anatomy of the day: Initial experience and dosimetric benefits","volume":"171","author":"Astrom","year":"2022","journal-title":"Radiother. Oncol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00345-015-1708-z","article-title":"Treatment of muscle invasive bladder cancer in the elderly: Navigating the trade-offs of risk and benefit","volume":"34","author":"VanderWalde","year":"2016","journal-title":"World J. Urol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.eururo.2025.03.017","article-title":"Bladder preservation strategies in muscle-invasive bladder cancer: Recommendations from the international bladder cancer group","volume":"89","author":"Gupta","year":"2026","journal-title":"Eur. Urol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1093\/jjco\/hyu129","article-title":"Patterns of practice in the radiation therapy for bladder cancer: Survey of the Japanese Radiation Oncology Study Group (JROSG)","volume":"44","author":"Maebayashi","year":"2014","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_85","first-page":"5761","article-title":"The use of external-beam radiotherapy for muscle-invasive bladder cancer in elderly or medically-fragile patients","volume":"37","author":"Aizawa","year":"2017","journal-title":"Anticancer Res."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1007\/s11604-025-01885-4","article-title":"Online adaptive radiation therapy for muscle-invasive bladder cancer: Short-course and high-precision definitive treatment for elderly or medically fragile patients","volume":"44","author":"Tokuda","year":"2026","journal-title":"Jpn. J. Radiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.clon.2024.01.005","article-title":"Improved dosimetry with daily online adaptive radiotherapy for cervical cancer: Waltzing the pear","volume":"36","author":"Yen","year":"2024","journal-title":"Clin. Oncol."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Peng, H., Zhang, J., Xu, N., Zhou, Y., Tan, H., and Ren, T. (2023). Fan beam CT-guided online adaptive external radiotherapy of uterine cervical cancer: A dosimetric evaluation. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-11089-6"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1016\/j.prro.2023.10.004","article-title":"Optimizing online adaptation timing in the treatment of locally advanced cervical cancer","volume":"14","author":"Yen","year":"2024","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"045030","DOI":"10.1088\/2057-1976\/acdf62","article-title":"Forecasting patient-specific dosimetric benefit from daily online adaptive radiotherapy for cervical cancer","volume":"9","author":"Ghimire","year":"2023","journal-title":"Biomed. Phys. Eng. Express"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"e176","DOI":"10.1016\/j.prro.2022.10.009","article-title":"Spare the bowel, don\u2019t spoil the target: Optimal margin assessment for online cone beam adaptive radiation therapy (OnC-ART) of the cervix","volume":"13","author":"Yen","year":"2023","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s13014-025-02688-7","article-title":"Moderately hypofractionated online adaptive radiotherapy (SWIFT-1) in cervical cancer patients: Study protocol for a multi-centered, open-label, two-arm, phase III, randomized controlled study","volume":"20","author":"Zeng","year":"2025","journal-title":"Radiat. Oncol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"100757","DOI":"10.1016\/j.phro.2025.100757","article-title":"Investigation of changes in planning target volume and regression probability of rectal boost using in-silico cone-beam computed tomography-guided online-adaptive radiotherapy","volume":"34","author":"Pierrard","year":"2025","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Storm, K.S., Astrom, L.M., Sibolt, P., Behrens, C.P., Persson, G.F., and Serup-Hansen, E. (2024). ROAR-A: Re-optimization based online adaptive radiotherapy of anal cancer, a prospective phase II trial protocol. BMC Cancer, 24.","DOI":"10.1186\/s12885-024-12111-1"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.radonc.2022.09.015","article-title":"Online adaptive radiotherapy of anal cancer: Normal tissue sparing, target propagation methods, and first clinical experience","volume":"176","author":"Astrom","year":"2022","journal-title":"Radiother. Oncol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s13014-020-01597-1","article-title":"Online adaptive radiotherapy compared to plan selection for rectal cancer: Quantifying the benefit","volume":"15","author":"Crama","year":"2020","journal-title":"Radiat. Oncol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"2488","DOI":"10.1093\/jnci\/djaf232","article-title":"Impact of daily adaptive head and neck radiotherapy on toxicity and quality-of-life: Results of the DARTBOARD phase II randomized trial","volume":"117","author":"Sher","year":"2025","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_98","first-page":"101012","article-title":"Palliative expeditiously adaptive quad shot radiotherapy for head and neck cancers (PEAQ-RT)","volume":"54","author":"Liu","year":"2025","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13014-024-02436-3","article-title":"Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer","volume":"19","author":"Blumenfeld","year":"2024","journal-title":"Radiat. Oncol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"110178","DOI":"10.1016\/j.radonc.2024.110178","article-title":"In silico evaluation and feasibility of near margin-less head and neck daily adaptive radiotherapy","volume":"197","author":"Dohopolski","year":"2024","journal-title":"Radiother. Oncol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13014-023-02390-6","article-title":"Prospects for online adaptive radiation therapy (ART) for head and neck cancer","volume":"19","author":"Guberina","year":"2024","journal-title":"Radiat. Oncol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"101256","DOI":"10.1016\/j.adro.2023.101256","article-title":"Early experience of online adaptive radiation therapy for definitive radiation of patients with head and neck cancer","volume":"8","author":"Avkshtol","year":"2023","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e14095","DOI":"10.1002\/acm2.14095","article-title":"Dosimetrically triggered adaptive radiotherapy for head and neck cancer: Considerations for the implementation of clinical protocols","volume":"24","author":"Dumont","year":"2023","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"368","DOI":"10.21037\/apm.2018.05.07","article-title":"The effect of early versus delayed radiation therapy on length of hospital stay in the palliative setting","volume":"7","author":"Cushman","year":"2018","journal-title":"Ann. Palliat. Med."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e13841","DOI":"10.1002\/acm2.13841","article-title":"Evaluation of a workflow for cone-beam CT-guided online adaptive palliative radiotherapy planned using diagnostic CT scans","volume":"24","author":"Nelissen","year":"2023","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"109538","DOI":"10.1016\/j.radonc.2023.109538","article-title":"Same-day adaptive palliative radiotherapy without prior CT simulation: Early outcomes in the FAST-METS study","volume":"182","author":"Nelissen","year":"2023","journal-title":"Radiother. Oncol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"100490","DOI":"10.1016\/j.phro.2023.100490","article-title":"Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapy","volume":"28","author":"Kejda","year":"2023","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"110840","DOI":"10.1016\/j.radonc.2025.110840","article-title":"Clinical feasibility of treatment planning on a diagnostic CT scan without or with single fraction plan adaptation in patients with stage II\/III rectal cancer","volume":"206","author":"Schuurhuizen","year":"2025","journal-title":"Radiother. Oncol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"100611","DOI":"10.1016\/j.phro.2024.100611","article-title":"Feasibility of simulation free abdominal stereotactic adaptive radiotherapy using an expedited pre-plan workflow","volume":"31","author":"Price","year":"2024","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"e14438","DOI":"10.1002\/acm2.14438","article-title":"The feasibility of CT simulation-free adaptive radiation therapy","volume":"25","author":"MacDonald","year":"2024","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.ijrobp.2025.02.045","article-title":"Direct-to-treatment adaptive radiation therapy: Live planning of spine metastases using novel cone beam computed tomography","volume":"122","author":"McGrath","year":"2025","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Wang, D., Kim, H., Zhuang, T., Visak, J.D., Cai, B., Parsons, D.D.M., Jiang, S., Godley, A.R., and Lin, M.H. (2025). Simulation-omitting and using library patients for pre-planning online adaptive radiotherapy (SUPPORT): A feasibility study for spine stereotactic ablative radiotherapy (SAbR) patients. Cancers, 17.","DOI":"10.3390\/cancers17071216"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1016\/j.ijrobp.2022.07.903","article-title":"Radiographer-led, CBCT-guided online adaptive radiotherapy for muscle invasive bladder cancer using artificial intelligence","volume":"114","author":"Shelley","year":"2022","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"e70195","DOI":"10.1002\/acm2.70195","article-title":"Improving efficiency in lung SAbR planning using integrated tools for X-ray based adaptive radiotherapy","volume":"26","author":"Visak","year":"2025","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e14587","DOI":"10.1002\/acm2.14587","article-title":"Body contour adaptation for weight-loss and bolus for head and neck radiotherapy on Ethos version 2.0 and HyperSight: Synthetic CT versus direct calculation","volume":"26","author":"Yashayaeva","year":"2025","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2755\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:08:45Z","timestamp":1787652525000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2755"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":116,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18172755"],"URL":"https:\/\/doi.org\/10.3390\/cancers18172755","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]}}}