International Journal For Multidisciplinary Research

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Volume 8 Issue 6
November-December 2026

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Effectiveness and Safety of Daily Adaptive Radiotherapy Versus Non-Adaptive Radiotherapy in Prostate Cancer: A Systematic Review

Author(s) Dr. Rakesh Kadam, Dr. Vridhi Khatri, Dr. Rhea Potdar, Dr. Steffi Barot, Dr. Pooja Meghani, Dr. Dipika Gupta, Dr. Teena Rathod, Dr. Yash Kalbare
Country India
Abstract Background:
The accuracy of radiation delivery and the dose delivered to adjacent healthy tissues can be affected by changes in prostate anatomy during radiotherapy. Daily adaptive radiotherapy (ART) solves these variations by adapting treatment regimens to the patient’s anatomy at each treatment fraction. This review assesses whether this approach has advantages over conventional non-adaptive radiotherapy (non-ART) in terms of treatment precision, normal tissue sparing, and treatment-related adverse events.

Methods:
A systematic review was conducted following PRISMA recommendations and prospectively registered in PROSPERO (CRD420251019512). Relevant publications from the previous decade were searched in PubMed and ClinicalKey. Eligible studies were comparative clinical investigations and dosimetric analyses in patients with prostate cancer treated with adaptive or non-adaptive radiotherapy. The outcomes of interest included target volume coverage, radiation dose to bladder and rectum, treatment-related toxicity, biochemical control, and survival. Study quality and risk of bias were assessed using assessment instruments appropriate for the study design. Qualitative synthesis was used because of heterogeneity in study characteristics and reported outcomes.

Results:
The review included 19 studies, comprising prospective observational studies, retrospective and comparative treatment-planning studies. Generally, the adaptive treatment strategies evaluated resulted in better target coverage and conformity while allowing for smaller planning target volume margins. Additionally, several dosimetric comparisons showed reduced radiation exposure to surrounding organs, notably the bladder and rectum. Clinically, there appears to be a potential reduction in acute gastrointestinal side effects. A select few studies have reported Grade 2 or higher toxicity rates of approximately 5-6% with ART compared with 14-15% with non-ART approaches. However, the data regarding genitourinary complications, late toxicity, biochemical disease control, and survival outcomes were insufficient to reach a definitive conclusion. In addition, the comparability was affected by the different treatment methods, study populations, and follow-up periods.

Conclusion:
Daily adaptive radiotherapy seems to offer dosimetric advantages compared to non-adaptive treatment in prostate cancer, primarily through enhanced target irradiation and reduced unnecessary irradiation of adjacent organs. Preliminary clinical experience indicates a possible role in reducing acute gastrointestinal toxicity. But none of these technical improvements have been supported by sufficient long-term clinical data to show a clear benefit in terms of oncological results or overall treatment safety. Further prospective comparative studies with larger samples, uniform treatment protocols, and adequate follow-up are needed to clarify its clinical value.
Keywords "prostate cancer", "adaptive radiotherapy", "non-adaptive radiotherapy", "image-guided radiotherapy", "magnetic resonance-guided radiotherapy", "online adaptive radiotherapy", and "daily adaptive radiotherapy".
Field Biology > Medical / Physiology
Published In Volume 8, Issue 6, November-December 2026
Published On 2026-11-03
DOI https://doi.org/10.36948/ijfmr.2026.v08i06.91252
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