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. Author manuscript; available in PMC: 2022 Apr 6.
Published in final edited form as: CA Cancer J Clin. 2021 Nov 18;72(1):34–56. doi: 10.3322/caac.21707

TABLE 1.

Recent Prospective Trials Examining Different Adaptive Strategies

REFERENCE NO. OF PATIENTS DESIGN/RANDOMIZATION/QUESTION ADDRESSED CONCLUSIONS
Vargas 200535 331

  • Phase 2, prostate cancer

  • Highest dose was selected on the basis of normal tissue tolerance constraints

  • Rectal toxicity rates in different dose levels and treatment groups to ascertain whether equivalent toxicity rates could be achieved

  • High doses were safely delivered in selected patients by ART

  • Rectal toxicity rates reflect dose-volume cutoff points
Spoelstra 200937 24

  • Patients with lung cancer eligible for chemoradiotherapy and gated delivery underwent 4D-CT after 15 fractions

  • Scan was coregistered with the initial planning 4D-CT, and a new planning target volume was generated based on the tumor visualized after 15 fractions

  • The role of ART is limited when respiratory-gated RT is used to reduce the toxicity related to concomitant chemoradiotherapy
Goodman 202138 225

  • Phase 2 trial, esophageal cancer/GEJ

  • Change in maximum standardized uptake value (SUV) from baseline was assessed

  • PET nonresponders (<35% decrease in SUV) crossed over to the alternative chemotherapy during chemoradiation (50.4 Gy/28 fractions); PET responders (≥35% decrease in SUV) continued on the same chemotherapy during chemoradiation

  • Adaptive treatment was promising using PET imaging as a biomarker to individualize therapy for patients with esophageal and GEJ adenocarcinoma

  • This approached improved pCR rates specifically in PET nonresponders
Kong 202141 138

  • Lung cancer

  • 127 Patients were enrolled (43 in the standard arm and 84 in the adaptive arm)

  • ART boost based on FDG-PET/CT scan during RT, and resimulation with CT scan was applied

  • PET-guided adaptive radiation boost increased in field tumor control by 11%

  • No difference was seen in overall survival, progression-free survival, or lung cancer-specific survival between treatment arms

Abbreviations; 4D, 4-dimensional; ART, adaptive radiotherapy; CT, computed tomography; FDG-PET, fluorodeoxyglucose-positron emission tomography; GEJ, gastroesophageal junction; Gy, grays; pCR, partial complete remission; PET, positron emission tomography; RT, radiotherapy.