Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer - Research Findings

Sep 21, 2026

Adaptive radiation therapy (ART) provides a dynamic way to manage structural and spatial changes during radiotherapy for locally advanced head and neck cancers, supported by daily Cone-Beam CT (CBCT). The study assesses initial real-world daily ART delivered via an online adaptive platform with intelligence-assisted workflows. Treatment used auto-contouring and deformation for organs at risk and targets, with physician-approved adjustments. Two plan types were generated and compared, then clinical and dosimetric outcomes were reviewed.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Abstract

Background

Methods

Results

Discussion

Introduction

Blumenfeld et al. Radiation Oncology (2024) 19:43 [https://doi.org/10.1186/s13014-024-02436-3](https://doi.org/10.1186/s13014-024-02436-3) Radiation Oncology RESEARCH Open Access Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer Philip Blumenfeld1*, Eduard Arbit1, Robert Den1,2, Ayman Salhab1, Tal Falick Michaeli1, Marc Wygoda1, Yair Hillman1, Raphael M. Pfeffer 1, Marcel Fang1, Yael Misrati 1, Noam Weizman1, Jon Feldman 1† and Aron Popovtzer 1† Abstract Background Adaptive radiation therapy (ART) offers a dynamic approach to address structural and spatial changes that occur during radiotherapy (RT) for locally advanced head and neck cancers. The integration of daily ART with Cone-Beam CT (CBCT) imaging presents a solution to enhance the therapeutic ratio by addressing inter-fractional changes. Methods We evaluated the initial clinical experience of daily ART for patients with head and neck cancer using an online adaptive platform with intelligence-assisted workflows on daily CBCT. Treatment included auto-contour and structure deformation of Organs at Risk (OARs) and target structures, with adjustments by the treating physician. Two plans were generated: one based on the initial CT simulation with the edited structures (scheduled) and a reoptimized plan (adaptive) . Both plans were evaluated and the superior one approved and delivered. Clinical and dosimetric outcomes were reviewed. Results Twenty two patients with head and neck cancers (7 Nasopharynx, 6 Oropharynx, 1 oral cavity, 8 larynx) stages I-IVA were treated with daily ART. 770 adaptive and scheduled radiotherapy plans were generated. 703 (91 . 3%) adaptive plans were chosen. Median time to deliver ART was 20 minutes (range: 18-23) . Adaptive compared to scheduled plans demonstrated improved mean V95 values for the PTV70, PTV59 . 5, and PTV56 by 1. 2%, 7. 2%, and 6. 0% respectively and a mean 1.4% lower maximum dose in PTV70 . Fourteen of 17 OARs demonstrated improved dosimetry with adaptation, with select OARs reaching statistical significance. At a median follow up of 14.1 months, local control was 95. 5%, two patients developed metastatic disease and four patients died. 9. 1% of patients had acute grade 3 dysphagia and 13. 6% had grade 2 chronic xerostomia. †Principal Investigators: equal contribution *Correspondence: Philip Blumenfeld [philipb@hadassah.org.il](philipb@hadassah.org.il) 1 Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002 Jerusalem, Israel 2 Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA © The Author(s) 2024, corrected publication 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver)[. The Creative Commons Public Domain Dedication waiver](http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver)[ ](http://creativecommons.org/licenses/by/4.0/. The Creative Commons Publi

FAQs

What problem does daily ART aim to address in head and neck cancer radiotherapy?

Daily ART targets structural and spatial changes that occur during radiotherapy, enabled by daily CBCT to enhance treatment precision and the therapeutic ratio.

How were treatment plans generated and selected in this study?

For each patient, two plans were produced: a scheduled plan based on the initial CT with edited structures and an adaptive reoptimized plan based on daily CBCT. The superior plan was approved and delivered.

What dosimetric and clinical outcomes were observed with adaptive vs scheduled plans?

Adaptive planning improved mean V95 values for multiple PTVs and reduced maximum dose in PTV70. Dosimetry improved for most organs at risk, and clinical outcomes included high local control with reported acute dysphagia and chronic xerostomia rates.

Sep 21, 2026

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