We Adapt: A Therapist's Perspective on the Origination of Adaptive Radiotherapy Program.

Purpose: In February of 2023, our Radiation Oncology Department began treating our first patients on our newest machine, an Ethos that treats using Adaptive Radiotherapy. The Ethos is a combination Linear Accelerator and CT scanner that can treat adaptive and non-adaptive patients. A highly targeted form of external beam radiotherapy, adaptive therapy personalizes cancer care by considering daily changes in anatomy and, with the help of AI, creates and adapts new treatment plans and QA with the patient on the treatment table. Depending on the site being treated, the workflow can be done anywhere from 15 minutes to 1 hour.

Methodology: A multidisciplinary collaboration of Radiation Oncology Physicians, Radiation Therapists and Physicists train and work side by side to implement an effective and efficient workflow, giving us the ability to produce high quality images through conebeam CT for more accurate treatment planning. Creative therapist scheduling and restructuring of physician and clinic schedules were required for success.

Results: A Doctor of the Day program was implemented into the department to assist with Adaptive treatments. The addition of HyperSight Imaging installed and went live on September 19, 2023 dramatically improved the image quality of the conebeam CT, making it much easier to see and contour critical structures. To date we have treated 300 adaptive fractions in the first 5 months and 55 adaptive patients completed treatment. The first adaptive protocol opened on 4/12/23 and the first protocol patient started treatment on 4/21/23.

Conclusions: The Ethos is a combination linear accelerator and CT scanner that can treat both adaptive and non-adaptive patients. Almost any candidate for SBRT is a candidate for adaptive therapy. Implementing an adaptive therapy program is a department wide commitment, is extremely time sensitive and has offered us a new refreshing skill set as we work side by side with our Physicians and Physicists.

References: Dr Eric Horwitz, M.D., Chairman Radiation Oncology of Fox Chase Cancer Center and the Lewis Katz School of Medicine at Temple University
Barbara McDonnell RT(T), Assistant Chief Radiation Therapist, Department of Radiation Oncology, Fox Chase Cancer Center
MaryAnn Konopka BS, RT(T) RT, Chief Radiation Therapist, Fox Chase Cancer Center