Patterns Of Practice in Adaptive and Real Time Particle Therapy part II: interfractional changes

Purpose/objectives: Adaptive particle therapy (APT) allows to account for anatomical changes throughout the treatment course resulting in more conformal target coverage and better sparing of organ at risk (OAR). Different types of APT ranging from weekly to daily to real-time adaptation have been proposed. Based on the POP-ART RT questionnaire [1], the Patterns Of Practice for Adaptive and Real-time Particle Therapy (POP-ART PT) questionnaire aims to determine the status of APT implementation worldwide. Here we focus on APT for interfractional anatomical changes in European centers.
Material/Methods: An institutional questionnaire was sent to particle therapy centers worldwide to determine the current extent of APT implementation in clinical practice. Respondents were asked if and which type of APT was used for selected treatment sites as well as details about the implemented workflow. Additionally, questions regarding the barriers to implementation and wishes for the future were addressed.
Results: Answers from 44 particle therapy centers worldwide have been received so far. Here we present the results for 23 European particle therapy centers from 13 countries, representing a 92% response rate for Europe. All responding centers except one use APT for at least one treatment site. The number of centers using APT for selected sites are shown in Table 1. None of the centers uses online APT (plan libraries or daily adaptation). The plan adaptation was in all cases motivated by both, target and OAR dose considerations. Reasons for adaptation are presented in Figure 1.
Three institutes are satisfied with their implemented adaptive workflows but would like to increase the number of treatment sites treated with APT. All other institutes would like to improve the plan adaptation workflow for a treatment site already treated with APT and 13 of those institutes would like to introduce APT to a new treatment site. One center explicitly stated that they would like to introduce an online adaptive workflow, first applied to skull base patients. Another center explicitly stated the aim to improve adaptive workflow efficiency. Other centers did not specify the type of improvement they wish for. The main barriers in the implementation of APT are presented in Figure 2. The biggest issues were the lack of integrated and efficient workflows and the lack of human resources.
Conclusion: Comprehensive data about APT implementation in clinical practice at particle centers were collected. Currently, no center uses online APT and more research and development for integrated and efficient workflow is needed to bring it to clinical practice. Until the end of the year, we will conclude data collection worldwide and summarize the results in a comprehensive report.