Impact of daily plan adaptation on organ-at-risk normal tissue complication probability for adrenal lesions undergoing stereotactic ablative radiation therapy

Highlights: • MR-guided adaptive adrenal SABR reduces the chance of stomach toxicity. • Reduction in predicted stomach toxicity was mainly for left adrenal lesions. • Consider dose escalation for right adrenal lesions due to low predicted toxicity. Stereotactic ablative radiotherapy (SABR) can achieve good local control for metastatic adrenal lesions. Magnetic resonance (MR)-guidance with daily on-table plan adaptation can augment the delivery of SABR with greater dose certainty. The goal of this study was to quantify the potential clinical benefit MR-guided daily-adaptive adrenal SABR using the normal tissue complication probability (NTCP) framework.