This is the first in a series of articles highlighting various radiation modalities, how they work, and what patients can expect from each one.
Radiation therapy has been a cornerstone of cancer treatment for decades, but advances in technology now allow care teams to tailor treatment more closely to each individual patient. One of the most advanced approaches is adaptive radiation therapy, a technique that allows radiation treatment to adjust as a patient’s body changes.
“Traditional radiation therapy is based on a plan we create before treatment begins,” said Dennis N. Stanley, Ph.D., associate professor and chief of Adaptive Therapy. “That approach works very well for many patients, but the human body isn’t static.”
Over the course of treatment, tumors can shrink, organs can shift, and everyday changes like digestion or bladder filling can subtly alter internal anatomy, sometimes affecting how precisely radiation is delivered.
Adaptive radiation therapy is designed to respond to those changes. Before each treatment session, patients undergo a new scan, typically an advanced CT scan, that shows exactly what their anatomy looks like that day. Using this real-time information, the care team can adjust the treatment plan if needed before radiation is delivered.
“You can think of adaptive therapy as adjusting the plan day by day instead of following a fixed roadmap,” Michael Soike M.D., associate professor and medical director for Adaptive Therapy said. “It allows us to stay focused on the tumor while minimizing radiation to healthy tissue.”
This approach is especially helpful for tumors located near sensitive organs or in areas of the body that naturally move, such as the lungs, abdomen, prostate, bladder, or pancreas. Tumors may also change significantly during treatment as they respond to radiation. By adapting the plan daily, clinicians can better account for these changes, which may help reduce side effects and, in some cases, allow for safer delivery of more effective radiation doses.
In many cases, adaptive therapy is planned from the beginning based on factors such as tumor location, proximity to critical organs, and the likelihood of anatomical change during treatment. In other situations, adaptive therapy can be added partway through treatment if changes are observed. This flexibility allows care teams to continuously tailor treatment to the patient’s needs.
An adaptive therapy appointment typically takes longer than a standard radiation session, often about 30 to 45 minutes. After the patient is positioned, a daily scan is performed. A multidisciplinary team of radiation oncologists, medical physicists, and radiation therapists then reviews the images and updates the treatment plan as needed using advanced software. Although much of this process happens quietly behind the scenes, it includes careful review, collaboration, and multiple safety checks before treatment is delivered.
Because the treatment plan is evaluated and refined each day, adaptive therapy includes additional safety measures beyond standard radiation therapy. A specially trained medical physicist is involved in each adaptive session, providing technical oversight to ensure the treatment is accurate and delivered exactly as intended.
Patients often notice that adaptive therapy visits take longer and may wonder what changes were made or whether those adjustments mean something has changed with their cancer.
“The adjustments are expected and don’t mean something is wrong,” Soike said. “They mean we’re fine-tuning treatment to make it as accurate as possible for that day.”
Overall, adaptive radiation therapy offers patients greater precision, better protection of healthy tissues, and reassurance that treatment is being customized throughout their care.
In most cases, adaptive therapy is covered similarly to standard radiation treatment, though insurance details can vary, and care teams are available to help patients navigate questions along the way.
“Adaptive therapy reflects where cancer care is headed,” Stanley said. “It’s about truly individualized treatment, responding to each patient’s anatomy, each day.”
As this spotlight series continues, we’ll explore additional modalities shaping the future of radiation oncology, all with the shared goal of delivering safer, more precise, and more personalized cancer care.