Advancing Prostate Cancer Treatment: A Review of CT and MR-Guided Online Adaptive Radiotherapy Techniques

Area of Science:

• Oncology
• Medical Physics
• Radiology

Background:

• Radiotherapy is a primary treatment for prostate cancer (PCa).
• Technological advancements are improving radiation precision and reducing toxicity.
• Adaptive radiotherapy (ART) represents a significant innovation in PCa management.

Purpose of the Study:

• To review the technical principles, clinical applications, and technological developments of ART in PCa management.
• To explore the roles of Magnetic Resonance (MR) and Computed Tomography (CT) imaging in ART.
• To compare offline and online ART workflows and CT-guided versus MR-guided approaches.

Main Methods:

• Review of current literature on ART in prostate cancer.
• Analysis of imaging modalities (MR and CT) for treatment planning and guidance.
• Comparison of different ART workflows (offline vs. online) and imaging guidance systems.

Main Results:

• ART enhances treatment precision through advanced imaging, real-time motion tracking, and on-table adaptive planning.
• MR and CT imaging provide crucial anatomical and functional data for ART.
• Both CT-guided and MR-guided ART improve radiation delivery via enhanced visualization, auto-segmentation, and plan adaptation.

Conclusions:

• ART has the potential to optimize therapeutic outcomes in PCa by adjusting radiation doses to anatomical changes.
• Imaging-guided ART minimizes damage to healthy tissues and increases dose delivery to targets.
• Evolving ART technologies promise safer dose escalation, reduced toxicity, and improved patient outcomes in prostate radiotherapy.