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In this presentation I will describe what ‘personalised radiotherapy’ means and discuss the work of the RTTs in our department regarding personalised radiotherapy.
Personalised radiotherapy, ‘ tailoring radiotherapy to patient specific characteristics’ can be described in general terms as customising a treatment based on patient and tumour characteristics using predictive treatment models to optimize cure with minimization of side effects, whilst incorporating the preference of the patient using shared decision making, and monitoring medical as well as mental response during treatment with the possibility to adapt treatment.
What is ‘personalised’ radiotherapy for me, as a RTT?
One aspect of personalised radiotherapy is making use of imaging technologies that help to personalise the radiation treatment with imaging such as PET, CT, MR, and CBCT, not only for the initial treatment plan, but also throughout the radiation treatment by monitoring the patient’s anatomy and physiology and acting upon changes with adaptive radiotherapy. RTTs have an important role in the evaluation and management of this process. Besides the technical and medical aspects, RTTs are also involved in the social aspects of the radiation treatment, e.g. by providing personalised guidance in the way of psychosocial support.
For our head and neck Cancer patients, RTTs personalize the radiotherapy by checking the daily CBCT scans for anatomical changes. If deviations from the planning CT scan are detected, an action protocol guides the RTTs to an adequate response. In case of gross anatomical changes, such as contour increase/decrease, target volume increase/decrease or target volume shifts, a dose recalculation of the treatment plan on the anatomy of the day is warranted. This method is used to assess the dosimetric effect of geometrical changes seen on CBCT to assist the radiation-oncologist in the decision whether a re-plan is necessary. A re-plan is typically requested when an under-dosage of the target volume is seen or an over-dosage of the OARs is seen. This workflow was designed to decrease the workload for radiation-oncologists by shifting daily review of CBCT to RTTs
During the course of treatment RTTs also monitor the patients’ wellbeing during daily contact. For instance by observing overall medical wellbeing (steady on their feet), regular weight measurements and wound care. Furthermore, the RTTs inquire about daily activities, support from  withfamily or  friends, personal hygiene and quality of life in order to be able to provide additional support or to refer patients if indicated to e.g. a social worker, dental hygienist, dietician etcetera. To conclude, RTTs have an important role in personalised radiotherapy for head and neck cancer.