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Advances in Radiotherapy
& Nuclear Medicine Review of image-guided adaptive radiotherapy

volumes, thereby minimizing the risk of brain necrosis. 61,62 and spatial distortions. Therefore, it is essential to regularly
A Phase II trial (NCT06405256) conducted at the Cancer assess the geometric distortion, image quality, and presence
Hospital of the Chinese Academy of Medical Sciences of artifacts. Implementing automated image QA analysis can
evaluated the use of MRI-guided ART in the treatment of expedite this QA process by efficiently identifying errors.
large brain metastases. Preliminary data demonstrated that The rapid technological advancements are expected
significant positional changes occurred in 30% of patients
during treatment. T2-FLAIR and T1 + C sequences showed to significantly enhance ART’s therapeutic effectiveness
superior contouring concordance, supporting multimodal by incorporating more sophisticated imaging techniques
imaging. ART is particularly beneficial for refractory lesions and AI algorithms. Ongoing research and clinical trials
with severe edema, large size, or functional location. 63 are continually expanding the scope of ART, providing
directions for better patient outcomes and improved
5. Conclusion cancer prognosis. This progress is driving the shift toward
a new era of personalized and precise RT.
Adaptive RT represents a significant advancement in the
field of tumor RT, providing a revolutionary approach that Acknowledgments
ingeniously integrates cutting-edge imaging technology
with AI to address dynamic changes in patient anatomy None.
and tumor size flexibly. The core value of AI in online ART
lies in its ability to automate, accelerate, and optimize key Funding
processes–including target delineation, plan optimization, None.
QA, and treatment response monitoring–thereby enabling
efficient and precise personalized therapy. AI-driven, deep Conflict of interest
learning-based automatic segmentation enables rapid The authors declare they have no competing interests.
and precise delineation of tumor targets and OARs. The
deep integration of AI and machine learning algorithms Author contributions
streamlines the ART workflow, substantially enhancing
the efficiency of automated delineation of tumor targets Conceptualization: Junjie Wang, Ping Jiang
and OARs. AI-powered treatment planning systems Formal analysis: Qiman Han, Suqing Tian, Runhong Lei
can re-optimize plans within minutes while performing Investigation: Qiman Han, Zhuhui Yuan, Yi Chen, Zhe Ji,
QA through dose calculation and error detection. In Yuliang Jiang
addition, by integrating radiomics and AI-based analytics Methodology: Junjie Wang, Ping Jiang
with multimodal data, dynamic monitoring of treatment Writing – original draft: Qiman Han, Zhuhui Yuan
responses and toxicity prediction can be realized. However, Writing – review & editing: Junjie Wang, Bin Qiu, Yi Chen
the integration of ART into clinical practice is not without
its challenges; it involves numerous obstacles that require Ethics approval and consent to participate
continuous innovation and refinement. 25 Not applicable.
Although current online ART systems have successfully
integrated multiple steps and achieved a high degree of Consent for publication
automation, they still encounter several technical bottlenecks. Not applicable.
For instance, the accurate delineation of OARs and target
areas continues to rely heavily on meticulous review and Availability of data
frequent manual adjustments by clinicians. Moreover, the All data for this study were obtained from the cited original
time-consuming nature of VMAT dose calculations limits articles.
ART treatment strategies primarily to intensity-modulated
radiation therapy. In clinical practice, MRI-based ART References
sessions last between 30 and 60 min, leading to a longer 1. Thariat J, Hannoun-Levi JM, Sun Myint A, Vuong T,
treatment duration. This not only increases patient discomfort Gérard JP. Past, present, and future of radiotherapy for the
but also reduces treatment compliance. More critically, benefit of patients. Nat Rev Clin Oncol. 2013;10(1):52-60.
extended treatment time can compromise the dosimetric
advantages of ART due to organ deformation or movement. doi: 10.1038/nrclinonc.2012.203
Furthermore, there are clinical translation gaps between 2. Schaue D, McBride WH. Opportunities and challenges
preclinical findings and routine practice. For example, in of radiotherapy for treating cancer. Nat Rev Clin Oncol.
MRI-guided ART, MRI images are susceptible to artifacts 2015;12(9):527-540.

Volume 3 Issue 3 (2025) 10 doi: 10.36922/ARNM025110012