Adaptive Radiation Turns Daily Imaging Into Precision Treatment
Summary
- For more than six years, the University of Miami Health System has delivered adaptive radiation therapy, using daily imaging to adjust treatment plans in real time for greater precision.
- By standardizing advanced platforms and workflows across multiple sites, UM has scaled adaptive radiation into a consistent, systemwide capability.
- Grounded in clinical data and ongoing research, adaptive radiation turns imaging into an active treatment tool, aligning therapy with each patient’s anatomy as treatment unfolds.
Every patient’s anatomy changes during radiation therapy. Tumors shift. Organs move. Bladders fill and empty. Weight fluctuates. Yet for decades, radiation plans were typically created once and delivered over weeks, even as those variables evolved.
At Sylvester Comprehensive Cancer Center, part of UHealth — University of Miami Health System, radiation oncologists have spent more than six years adapting radiation treatment day by day. Using daily imaging, clinicians recalibrate plans so each dose reflects the patient’s anatomy at that moment. The result is a highly individualized approach to radiation therapy that turns imaging from a verification step into an active treatment tool.
This capability, known as adaptive radiation therapy, or ART, is now a routine part of care across UHealth’s radiation oncology network.
“Adaptive radiation is about responding to what we see today, not what we assumed weeks ago,” said Markus Bredel, M.D., Ph.D., chairman and Sylvester professor of radiation oncology at the University of Miami Miller School of Medicine. “The goal is always the same: deliver the best dose to the target while respecting what’s around it.”
While ART is gaining momentum, it is not yet mainstream in cancer care. Only a minority of institutions have adopted the precision-based approach, with some academic and National Cancer Institute-designated cancer centers, such as Sylvester, serving as early adopters.
When the Plan Learns in Real Time
Most patients imagine radiation therapy as something carefully aimed at the start, then delivered the same way each day. ART shifts that mental model.
At Sylvester, each treatment session begins with imaging that captures the patient’s anatomy as it exists that day.
“When changes are clinically meaningful, the plan is adjusted before treatment proceeds,” Dr. Bredel said. “The result is an iterative, patient-specific plan because adaptive therapy treats motion and change as part of the design, not a problem to work around.”
Scaling Precision: A Fleet, Not a One-Off
Innovations in radiation oncology often work well in isolated settings but may struggle to scale. Sylvester’s adaptive radiation program was built with that challenge in mind.
Rather than relying on individualized setups, the health system standardized platforms, protocols and workflows across facilities. The approach is closer to managing a fleet than a single aircraft. When systems are aligned — shared instruments, procedures and safety checks — complex operations can be repeated with confidence across all locations, including the newest facility in North Miami, UHealth SoLé Mia.
That standardization allows ART to be delivered consistently without diluting quality. That’s important in clinical trials where standards must be reproducible. It also means Sylvester’s precision medicine capability in radiation oncology is built to evolve universally at all facilities.
“Standardization is the difference between having an advanced technology and actually mastering it,” said Brandon Mahal, M.D., associate professor and vice chair of radiation oncology at Sylvester. “When platforms, workflows and teams are aligned, precision isn’t dependent on where a patient is treated. It becomes the standard everywhere.”
Dr. Mahal noted that all Sylvester locations are equipped with leading-edge machines capable of delivering advanced treatments such as ART.
“Our ability to adapt radiation in real time allows us to treat tumors previously considered inoperable or too high risk,” Dr. Mahal said.
It also reduces toxicity, lowers complication rates, produces fewer unplanned admissions and improves local control. The result is better safety metrics, stronger survival performance and better care for complex gastrointestinal, genitourinary and pancreatic cancers, he explained.
Adaptive, but Evidence-Built
Although ART represents a shift in how radiation therapy is delivered, it is not improvisation. The broader field has been actively studying how image guidance and adaptive approaches are reshaping prostate cancer radiotherapy, including multicenter evaluations of MRI-guided ART.
UM’s own research ecosystem adds another layer. Investigators at Sylvester have spent years pairing advanced imaging with biologic markers to refine prostate cancer treatment decisions. Supported by an NCI-funded R01 and an extensive imaging and biospecimen repository, researchers have developed models that use MRI techniques and liquid biopsy markers to help guide treatment intensity over time.
The philosophy is consistent. Don’t treat from assumptions. Treat from signals.
Trials That Reflect the Adaptive Mindset
Benjamin Spieler, M.D., an associate professor of radiation oncology at the Miller School and clinical director of UHealth’s adaptive radiotherapy program, leads clinical trial work that reflects this precision-and-adjustment philosophy. In prostate cancer, Dr. Spieler is principal investigator of the Miami UAdapt trial, a phase 2 study evaluating MRI-guided LEAD stereotactic radiotherapy approaches, with or without ultra-short-term androgen suppression. The study incorporates multiparametric MRI-driven targeting and longitudinal outcome endpoints.
Dr. Spieler also leads the Miami EMPIRE Trial, a study that combines high-dose, multisite stereotactic radiotherapy with dual immunotherapy in the treatment of metastatic pancreatic cancer, and the Miami RADAR Trial, which focuses on radiosurgical debulking of asymptomatic or radiographic spinal cord compression.
These trials represent novel advances in adaptive radiation, fusing AI-optimized adaptive planning with diagnostic-quality day-of-treatment imaging to deliver the highest-quality and most technologically advanced radiotherapy available in the world.
“Our cancer center and department leadership have empowered this adaptive program to become a national leader in cancer care, and Sylvester is at the forefront of a revolution in radiation therapy,” Dr. Spieler said. “Our mission is to deliver the highest quality care for our patients, and adaptive radiotherapy represents the best of personalized, precision oncology.”
For patients, ART means care is precise and responsive—treatment that adapts as their bodies change. For clinicians, it brings radiation oncology closer to its ideal: the right dose, to the right place, under the right conditions.
“We’ve made precision routine, so advanced care is not a special case,” Dr. Bredel said. “The more seamlessly these workflows are integrated, the more consistently patients benefit.”
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Tags: Department of Radiation Oncology, Dr. Benjamin Spieler, Dr. Brandon Mahal, Dr. Markus Bredel, immunotherapy, Newsroom, precision medicine, prostate cancer, Radiation oncology, Sylverster Comprehensive Cancer Center