ADAPTNOW: High-Precision Cancer Treatment by Online Adaptive Proton Therapy

This project is funded by ZonMw, grant number 10-10400-98-14012
April 2015 – April 2019
Principal investigator from LUMC: dr. Marius Staring

A highly promising approach for treatment of cancer patients with radiation is Intensity Modulated Proton Therapy (IMPT), which is a new and most advanced form of proton therapy. 

The use of protons to irradiate the tumor has some distinct advantages over using photons. When a high-energy proton beam enters the patient’s body it deposits only a small dose along its path. The absorbed dose increases gradually with greater depth and rises to a greatly localized dose peak in the tumor. This peak is known as the Bragg peak. In this context, IMPT has a unique potential to spare healthy tissues. However, the highly localized dose deposition makes proton therapy and IMPT in particular, very sensitive to often observed daily variations in the patient’s anatomy (motion, bladder filling, tumor regression, etc.).

These variations will, if not adequately dealt with, cause severe overdose to healthy tissues and/or an underdose in the tumor. In the ADAPTNOW project we will develop a unique method to depict the internal anatomy just before treatment, and subsequently quickly adapt the treatment plan compensating for the observed variations. This will allow for more accurate targeting of the tumor, with higher dose delivery, while simultaneously reducing irradiation of healthy tissues, thereby reducing complications.

This project is a Medical Delta collaboration between Delft University of Technology, Erasmus Medical Center, Leiden University Medical Center, the Holland Particle Therapy Centre and industry, funded by a ZonMw grant. Involved from LUMC are dr. Marius Staring, prof. Boudewijn Lelieveldt (LKEB, Radiology) and prof. Corrie Marijnen (Radiation Oncology). We will focus on image registration techniques enabling near real-time adaptation of the treatment planning.

Associated researchers


  • Y. Qiao, "Fast optimization methods for image registration in adaptive radiation therapy," PhD thesis, Leiden University Medical Center, December 2017
  • M.S. Elmahdy, T. Jagt, M.S. Hoogeman, R. Zinkstok and M. Staring, " Evaluation of multi-metric registration for online adaptive proton therapy of prostate cancer," International Workshop on Biomedical Image Registration (WBIR), in press
  • E. Lens, T. Jagt, M. Hoogeman, M. Staring and D.R. Schaart, " Using prompt gamma emission profiles to monitor day-to-day dosimetric changes in proton therapy," ESTRO 37, in press