Exploring the value of online adaptive image-guided radiotherapy: A scoping review

To facilitate informed decision-making, it is important to understand what value online adaptive image-guided radiotherapy (ART) provides for patients, professionals and society. This review aimed to summarize how the value of online ART is described and measured in literature, by providing an overview of the outcome measures used to define value and the relevant reflections on online ART’s value. We systematically searched PubMed, Embase, and the Cochrane Library for original articles on online, adaptive image-guided radiotherapy with a focus on re-planning. Both qualitative and quantitative studies were included. For quantitative studies, we extracted outcome measures, study details, system used, and treatment characteristics. For qualitative studies, we extracted value-related text lines, study details and information on innovation and patient study sample. We included 89 publications, 59 publications of quantitative studies 30 qualitative studies. In the quantitative studies toxicity (75%) was most frequently measured, followed by survival (>56%). Less frequent measures included disease progression, quality of life and patient acceptance. In the qualitative studies four main themes emerged: enhancing treatment accuracy to improve clinical outcomes and patient comfort, advancing professional expertise, lack of clinical evidence, and financial implications. This review summarizes how the value of online ART is represented in literature. While clinical outcomes such as toxicity and survival are reported in nearly all quantitative studies, broader reflections highlight also patient aspects, advancing professional expertise and financial considerations. Integrating both quantitative and qualitative insights is crucial to fully capture the value of online ART.