A previous approach to robust intensity-modulated radiation therapy (IMRT) treatment planning for moving tumors in the lung involves solving a single planning problem before the start of treatment and using the resulting solution in all of the subsequent treatment sessions. In this paper, we develop an adaptive robust optimization approach to IMRT treatment planning for lung cancer, where information gathered in prior treatment sessions is used to update the uncertainty set and guide the reoptimization of the treatment for the next session. Such an approach allows for the estimate of the uncertain effect to improve as the treatment goes on and represents a generalization of existing robust optimization and adaptive radiation therapy methodologies. Our method is computationally tractable, as it involves solving a sequence of linear optimization problems. We present computational results for a lung cancer patient case and show that using our adaptive robust method, it is possible to attain an improvement over the traditional robust approach in both tumor coverage and organ sparing simultaneously. We also prove that under certain conditions our adaptive robust method is asymptotically optimal, which provides insight into the performance observed in our computational study. The essence of our method – solving a sequence of single-stage robust optimization problems, with the uncertainty set updated each time – can potentially be applied to other problems that involve multi-stage decisions to be made under uncertainty. 
Adaptive and robust radiation therapy optimization for lung cancer