# 5D Cancer Services — Adaptive Radiotherapy > 5D Cancer Services is a US-based radiation oncology provider specialising in adaptive radiotherapy (ART). The practice is built around the A.I.M. framework — Adaptation, Imaging, and Margins — which enables treatment plans to be re-imaged and re-planned before every session rather than once at the start of a course. Most patients complete treatment in approximately 5 days rather than the 20–45 sessions required by conventional plans. The full text of this site's main pages, compiled from the live site. ## Adaptive Radiotherapy Cancer Treatment URL: https://www.5dcancerservices.com/ Skip to main content Smarter, safer cancer treatment in as few as 5 days. Adaptive radiotherapy is a leap forward in cancer care. By adjusting your treatment plan daily based on your anatomy, we target tumors with sub-millimeter precision while protecting healthy tissue. What makes adaptive radiotherapy different? Conventional radiation uses a single plan delivered over weeks. But your body changes every day. Adaptive radiotherapy re-images and re-plans your treatment at every single session. Sub-millimeter Precision — Because we adapt the plan daily, we use smaller margins. The radiation hits the tumor, not the healthy tissue around it. Weeks Faster — Higher precision means we can safely deliver higher doses per session. Treatments typically take 5 days instead of 20 to 45. Fewer Side Effects — By actively protecting surrounding organs, clinical trials show significantly fewer long-term side effects compared to conventional plans. Conditions we treat Prostate Cancer Lung Cancer Liver & Pancreatic Cancer Head & Neck Tumors Brain Metastases Oligometastatic Disease Treatment guided by A.I.M. Three interlocking principles drive every decision we make — from the imaging suite to the treatment table. Adaptation — We re-plan your treatment daily to match your anatomy as it is today. Imaging — High-resolution real-time imaging before every session gives us a precise, current picture of the tumor. Margins — Seeing clearly each day lets us treat with tighter margins, protecting more healthy tissue with every dose. Contact 5D Cancer Services at (435) 900-7060 to request a consultation. ## What is Adaptive Radiotherapy? URL: https://www.5dcancerservices.com/adaptive-radiotherapy Skip to main content A new standard in precision cancer treatment. Adaptive radiotherapy is an approach that adjusts your radiation plan daily, accounting for changes in your anatomy. It allows for safer, faster, and more focused treatment. The limits of conventional radiation In conventional radiation therapy, a treatment plan is created once, based on a single CT scan taken weeks before treatment begins. That same plan is then used for 20 to 45 sessions. Your body is not static. Tumors shrink as they respond to treatment. Internal organs like the bladder and rectum fill and empty, shifting day to day. Breathing causes constant movement. How adaptive radiotherapy solves this Adaptive radiotherapy takes new 3D images of your anatomy at every single session while you are on the treatment table. Advanced software then recalculates and optimizes the radiation delivery for your exact anatomy in that moment. Daily Imaging — High-resolution 3D scans reveal exactly where the tumor and organs are today. Live Re-planning — The plan is recalculated to hit the target and avoid healthy tissue. Precise Delivery — Sub-millimeter targeting allows for higher, safer doses in fewer days. Key terms explained Fraction — A single radiation treatment session. Adaptive radiotherapy often uses far fewer, larger fractions. Simulation — The planning scan taken before treatment begins. Margin — Extra space added around a tumor to account for uncertainty. Smaller margins mean less healthy tissue is exposed. Hypofractionation — Delivering a higher dose of radiation in fewer sessions. Daily adaptation is what makes this safe. Online adaptation — Re-planning your treatment while you are on the table, using a scan taken moments earlier. Stereotactic radiotherapy (SBRT/SRS) — Highly focused, high-dose radiation delivered with sub-millimeter precision. Who can benefit? Adaptive radiotherapy is especially valuable for cancers of the prostate, lung, liver, pancreas, and head and neck, as well as brain metastases and oligometastatic disease. ## The Case for Adaptive Radiotherapy URL: https://www.5dcancerservices.com/why-adaptive Skip to main content The case for adaptive radiotherapy. Why settling for a static treatment plan is no longer the standard for complex tumors. Why static plans fall short For decades, radiation oncology has operated on a fundamental compromise: because doctors could not see exactly where the tumor was on the day of treatment, they had to irradiate a larger area just in case. Adaptive radiotherapy is designed to remove that compromise. Tumors Shrink and Shift — Many tumors can lose a meaningful portion of their volume between the first scan and the final session. Daily Organ Movement — Organs in the abdomen and pelvis change size and shape daily based on digestion and hydration. The margin problem To compensate for uncertainty, conventional radiation relies on a Planning Target Volume (PTV): a safety margin of several millimeters added around the tumor. This guarantees that healthy tissue inside that margin is irradiated. The adaptive solution Shrinking Margins — Because we image and adapt the plan immediately before turning on the beam, we do not need large safety margins. Protecting Healthy Tissue — By tracking the daily position of critical organs, the adaptive plan steers the radiation dose away from healthy structures. Fewer Side Effects — Tighter margins mean less healthy tissue is exposed. What this means for you Quality of life — Protecting the bladder, bowel, salivary glands, or healthy lung helps preserve everyday function long after treatment ends. Less disruption — A course measured in days rather than weeks means fewer trips to the clinic. Confident dosing — When the target is confirmed every day, clinicians can deliver a strong, focused dose. ## How Adaptive Radiotherapy Works URL: https://www.5dcancerservices.com/how-it-works Skip to main content Inside the adaptive workflow. A look at how we recalculate your treatment plan in real time, every single day. Online vs. offline adaptation Online adaptation: The plan is adapted while you are lying on the treatment table. We scan, identify your exact anatomy, recalculate, and deliver — all in one visit. Offline adaptation: Clinicians review scans after a session and adjust the plan for a later visit — helpful for slow changes but unable to respond to real-time organ movement. Step by step: an online session Daily setup & imaging — You are positioned on the treatment table. A high-resolution CT or CBCT scan captures a 3D image of your internal anatomy exactly as it is that day. Assisted contouring — Advanced software compares today's scan with your original plan and redraws the boundaries of the tumor and surrounding healthy organs. Physician review & re-planning — Your radiation oncologist and medical physicist review the new contours and calculate a brand-new delivery plan. Treatment delivery — Once the new plan passes rigorous safety checks, the radiation is delivered. An entire online adaptive session takes roughly 30 to 45 minutes. What you will feel during a session Radiation treatment itself is painless. You will not see, hear, or feel the radiation as it is delivered. Your main job is to lie still and breathe normally. The team behind your treatment Radiation Oncologist — The physician who leads your care, sets the treatment goals, and approves the adapted plan. Medical Physicist — Ensures the radiation plan is accurate and safe. Radiation Therapists — Position you on the table, operate the equipment, and stay in constant communication. Dosimetrist — Works with the physicist and physician to shape the dose. Plan on roughly 30 to 45 minutes per visit. A full course is often completed in as few as five visits. ## Imaging & Precision URL: https://www.5dcancerservices.com/imaging Skip to main content Vision is everything. You cannot target what you cannot see. Our approach relies on advanced 3D imaging at every session to ensure sub-millimeter precision. The power of daily imaging In adaptive radiotherapy, imaging is not just for diagnosis. It is the foundation of the treatment itself. We use advanced technologies such as Cone Beam CT right on the treatment machine to capture a clear picture of your anatomy moments before treatment begins. Imaging modalities Cone Beam CT (CBCT) — A 3D scan taken on the treatment machine itself, moments before the beam turns on. Diagnostic-quality CT — Higher-detail CT imaging gives clearer soft-tissue contrast. Motion management — Techniques that account for breathing and natural organ movement. How we achieve sub-millimeter accuracy Tracking motion — We can see if a tumor has shifted due to breathing or organ filling, and adjust the target accordingly. Monitoring shrinkage — As the tumor shrinks over the course of treatment, we see it and adapt the beam. Enabling hypofractionation — This level of confidence is what allows us to safely deliver higher doses in fewer sessions. What precision means for side effects Every millimeter matters. Side effects from radiation largely come from the healthy tissue that sits in the beam's path. When daily imaging lets us shrink the safety margin around a tumor, far less of that healthy tissue is exposed. Common questions about imaging Why does imaging happen at every session? Your anatomy changes day to day as tumors respond and organs fill and empty. Imaging at every session lets us treat the body as it is that day. Is the daily imaging safe? The imaging used to guide treatment uses low doses compared with the therapeutic radiation, and it is a routine, painless part of each session. ## Conditions We Treat URL: https://www.5dcancerservices.com/conditions Skip to main content Conditions we treat. Adaptive radiotherapy excels at treating tumors located near critical organs, tumors that move when you breathe, and tumors that shrink rapidly during treatment. Prostate Cancer The prostate gland sits between the bladder and rectum, both of which change size dramatically day to day based on digestion and hydration. Challenge: A static plan must add wide margins to account for this movement, exposing the bladder and rectum to radiation. Solution: Adaptive radiotherapy tracks these daily shifts, allowing a curative dose to be delivered to the prostate in as few as 5 sessions (SBRT) while protecting the surrounding organs. Supporting trials: HERMES (NCT04172923), DESTINATION 2 (NCT04272489), ASPIRE (NCT03815019) Lung Cancer Lung tumors present a unique challenge: they move constantly as you breathe, and they often shrink rapidly during treatment. Solution: Daily adaptation and motion management ensure the beam follows the tumor exactly, protecting healthy lung and helping preserve respiratory function. Liver & Pancreatic Cancer Tumors in the abdomen are surrounded by highly sensitive organs such as the stomach and intestines. Solution: By precisely monitoring the daily position of these critical organs, adaptive therapy can safely escalate the dose toward a curative level. Supporting trials: SMART Pancreas (NCT02621229), MR-guided Liver SBRT (NCT02683200) Brain Metastases When cancer spreads to the brain, extreme precision is required to protect cognitive function, vision, and the brainstem. Solution: Adaptive stereotactic radiosurgery (SRS) targets multiple metastases with sub-millimeter accuracy, usually in 1 to 5 sessions. Supporting trials: UNITED (NCT03713385), UNITED-3 (NCT04172753) Head & Neck Tumors Patients with head and neck cancers often experience significant weight loss and tumor shrinkage during a multi-week course of treatment. Solution: Adapting the plan as the anatomy changes keeps the dose on the tumor and helps preserve swallowing, saliva production, and quality of life. Supporting trial: MSK Adaptive H&N Study (NCT03096808) Oligometastatic Disease For patients whose cancer has spread to a limited number of sites, focused radiation can play a powerful, non-invasive role. Solution: Adaptive radiotherapy can target lesions in the bones, lymph nodes, or organs with precision, helping bring limited-spread disease under control quickly. ## The Patient Journey URL: https://www.5dcancerservices.com/patient-journey Skip to main content What to expect. We are committed to making your treatment experience as smooth, comfortable, and reassuring as possible. 1. Initial Consultation — About 60 minutes You will meet with a specialized radiation oncologist to discuss your diagnosis, review your medical history and prior imaging, and determine whether adaptive radiotherapy is the right approach for you. How to prepare: Bring a list of your medications, any recent scans or pathology reports, and the questions that matter most to you. A family member or friend is welcome to join. 2. Simulation & Planning — About 30 to 60 minutes We schedule a simulation appointment to take precise CT or MRI scans of your body in the exact position you will be treated in. How to prepare: You may receive specific instructions, such as arriving with a full or empty bladder. Wear comfortable clothing. 3. Treatment Days — As few as 5 sessions, about 30 to 45 minutes per visit At each visit you lie comfortably while a new image is taken, your plan is adapted in real time to match that day's anatomy, and the precise dose is delivered after safety checks. How to prepare: Most people continue their normal routine between sessions. Follow any hydration or diet guidance from your team. 4. Follow-up & Care — Ongoing Many patients experience fewer side effects and return to their normal lives quickly. We monitor your progress closely with regular follow-up visits and imaging. Support for you and your loved ones A cancer diagnosis affects the whole family. Throughout your treatment, our team is here to explain each step in plain language, coordinate with your other doctors, and make sure you and your caregivers always know what comes next. ## Our Care Philosophy URL: https://www.5dcancerservices.com/care-philosophy Skip to main content The Philosophy of A.I.M. Three principles that guide every treatment decision we make — and every outcome we strive for. At 5D Cancer Services, we believe every patient should be given the opportunity to receive adaptive treatment — the future standard for personalized cancer care. We embrace the acronym of A.I.M., which stands for Adaptation, Imaging, and Margins. A — Adaptation Every patient's anatomy changes between sessions — tumors shrink, bladders fill, organs shift. We adapt the treatment plan daily to account for these changes, so radiation always targets the tumor as it exists today, not as it appeared on a scan taken weeks ago. I — Imaging Accurate adaptation is only possible with excellent imaging. Before every session, our system acquires high-quality real-time images of the treatment area. This gives our team a precise, current picture of the tumor and surrounding anatomy — the foundation for safe, targeted care. M — Margins Because we can see exactly where the tumor is each day, we can treat with tighter margins — delivering radiation precisely where it is needed while exposing less healthy tissue. Margin reduction is the single most critical factor in avoiding, or minimising, side effects. At 5D Cancer Services, we believe every patient should be given the opportunity to receive adaptive treatment as this represents the future standard for personalized cancer care. The ability to successfully adapt treatment plans and account for daily changes in cancer shape and position is dependent upon excellent pre-treatment and real-time imaging. These two features together allow for margin reduction — the most critical factor for avoiding, or at least minimizing, side effects. — The clinical team at 5D Cancer Services ## Research & Evidence URL: https://www.5dcancerservices.com/research Skip to main content Key Clinical Trials Brain Trial NCT ID Sponsor Key outcomes UNITED NCT03713385 ViewRay Demonstrated feasibility of MR-guided adaptive SBRT for brain metastases; supported sub-millimetre targeting accuracy. UNITED-3 NCT04172753 ViewRay Ongoing phase III; evaluates adaptive MR-guided radiosurgery vs. standard SRS for brain metastases. Gynecologic Trial NCT ID Sponsor Key outcomes EMBRACE I NCT00432172 GEC-ESTRO MRI-guided adaptive brachytherapy showed substantially improved local control and reduced morbidity in cervical cancer vs. historical controls. EMBRACE II NCT02247414 GEC-ESTRO Prospective cohort confirming dose-volume parameter goals; ongoing refinement of adaptive brachytherapy protocols. Head & Neck Trial NCT ID Sponsor Key outcomes MSK Adaptive H&N Study NCT03096808 Memorial Sloan Kettering Adaptive re-planning reduced dose to parotid glands and spinal cord as anatomy changed during treatment, preserving salivary function. Liver Trial NCT ID Sponsor Key outcomes MR-guided Liver SBRT NCT02683200 University of Colorado Online adaptive MR-guided SBRT enabled safe dose escalation to liver tumors with real-time organ-at-risk tracking. Multi-cancer Trial NCT ID Sponsor Key outcomes MOMENTUM NCT04075305 ViewRay (multi-institution) Registry study across tumour types demonstrating MR-Linac-based adaptive radiotherapy is safe and deliverable at scale. Pancreas Trial NCT ID Sponsor Key outcomes SMART NCT02621229 University of California San Diego MR-guided adaptive SBRT (5 fractions) achieved high rates of local control in pancreatic cancer with low rates of severe GI toxicity. Prostate Trial NCT ID Sponsor Key outcomes HERMES NCT04172923 Centre Léon Bérard Phase II; evaluates MR-guided adaptive SBRT (5 fractions) for localised prostate cancer with daily on-table adaptation. DESTINATION 2 NCT04272489 Erasmus MC Assesses adaptive MR-Linac SBRT for prostate cancer, focusing on toxicity reduction through daily plan adaptation. ASPIRE NCT03815019 Sunnybrook Health Sciences Prospective registry evaluating clinical outcomes of MR-guided adaptive radiotherapy for prostate and other cancers. Rectal Trial NCT ID Sponsor Key outcomes MARS NCT04246684 MR-Linac Consortium Investigates online adaptive MR-guided radiotherapy for rectal cancer as a route to organ preservation (watch-and-wait). Adaptive Boost Trial NCT03158077 University Medical Centre Utrecht Adaptive simultaneous integrated boost in rectal cancer; assessed tumour response and normal-tissue sparing. ## Frequently Asked Questions URL: https://www.5dcancerservices.com/faq Skip to main content Frequently Asked Questions Clear, honest answers to help you understand your treatment options. What is adaptive radiotherapy? Adaptive radiotherapy is an advanced form of radiation treatment where the treatment plan is adjusted (adapted) while the patient is on the treatment table by taking daily imaging to see exactly where the tumor and healthy organs are that day. How is this different from conventional radiation? In conventional radiation, a single plan is created at the beginning and used for all 20 to 45 sessions. Adaptive radiotherapy creates a new, customized plan for every single session based on real-time anatomy. Why can the treatment be done in 5 days instead of weeks? Because we have absolute certainty about the tumor's location each day, we can safely deliver a much higher dose of radiation per session without damaging nearby healthy tissue. This hypofractionation allows us to complete a full course in typically 5 sessions. Is the radiation dose higher overall? The total biological dose is comparable to conventional treatment, but it is delivered in fewer, larger fractions. The key is precision — the high dose is tightly sculpted to the tumor. What does online vs offline adaptation mean? Online adaptation happens while you are on the treatment table — we image, re-plan, and treat within the same session. Offline adaptation means we review images between sessions and adjust the plan for your next visit. Are there side effects? All radiation therapy carries some risk of side effects. Clinical trials have shown that the extreme precision of adaptive radiotherapy can significantly reduce damage to healthy tissue. How long does a daily session take? An online adaptive session typically takes 30 to 45 minutes. Does insurance cover this? Adaptive radiotherapy is covered by Medicare and most major private insurers for approved indications such as prostate, lung, and liver cancers. Does it hurt? No. The radiation delivery itself is completely painless and invisible, much like getting a standard X-ray or CT scan. Am I radioactive afterward? No. External beam radiation does not make your body radioactive. You are perfectly safe to be around family and friends immediately after your session. What conditions are best suited for this? It is highly effective for tumors in the abdomen and pelvis like prostate, pancreas, and liver, as well as lung tumors, brain metastases, and oligometastatic disease. How quickly can I start treatment? Once you have your initial consultation and simulation appointment, we typically begin treatment within one to two weeks. Do I need a referral? While many patients are referred by their urologist or oncologist, you can also contact us directly for a second opinion or consultation. ## Our Locations URL: https://www.5dcancerservices.com/locations Skip to main content Our Locations 5D Cancer Services operates advanced adaptive radiotherapy centers across the Southwest United States. St. George, UT — Southern Utah Area Southern Utah, St. George, UT Phone: (435) 900-7060 5D Cancer Services is headquartered in the beautiful red rock landscape of Southern Utah, serving patients locally and those traveling from across the country. Bullhead City, AZ 2755 Silver Creek Road, Suite 115 & Suite 125, Bullhead City, AZ 86422 Advanced adaptive radiotherapy now available in the tri-state area. Targeted, efficient, safer cancer treatment in as few as 5 days. ## Our Team URL: https://www.5dcancerservices.com/team Skip to main content Our Expert Team Adaptive radiotherapy requires specialized expertise. Our clinicians and operators bring decades of radiation oncology and medical-device leadership to every patient's care. Erick Gonzales — Chief Executive Officer Erick brings more than 22 years of experience in medical-device and radiation-oncology business development. His career spans leadership roles with ViewRay (MR-Linac adaptive therapy), DermEbx, and Xoft IORT, giving him deep expertise in bringing advanced radiation technologies to clinical practice. He holds a B.S. in Biology from the University of Southern California. Ritchie N. Stevens, M.D. — Chief Medical Officer Dr. Stevens is a board-certified radiation oncologist with 32 years of experience at Sunrise Hospital in Las Vegas, where he built one of the largest brachytherapy practices in the western United States. He serves as CMO of Access Radiation Oncology and 5D Cancer Services, guiding the clinical strategy and quality standards that underpin every patient's care. ## Blog & Insights URL: https://www.5dcancerservices.com/blog Skip to main content Insights & Education Articles, updates, and deep dives into the science of precision radiation oncology. The Future of Prostate Cancer Treatment: Why 5 Days is the New Standard Clinical Insights • October 12, 2023 For decades, treating prostate cancer with radiation required daily visits for up to 9 weeks. With the advent of adaptive SBRT, patients are returning to their normal lives in just 5 days. Understanding Hypofractionation: Doing More with Less Education • November 04, 2023 What exactly does hypofractionation mean, and why is extreme precision required to make it safe? A deep dive into radiation biology. Online vs. Offline Adaptive Therapy: What's the Difference? Technology • December 18, 2023 Many centers claim to offer adaptive therapy, but not all adaptation is created equal. Understanding the vital difference between real-time and delayed re-planning. Protecting the Rectum and Bladder: Reducing GI/GU Toxicity Patient Care • January 22, 2024 How daily anatomical tracking allows us to actively bend the radiation dose away from sensitive pelvic organs during treatment. ## The Future of Prostate Cancer Treatment: Why 5 Days is the New Standard URL: https://www.5dcancerservices.com/blog/future-of-prostate-cancer-treatment Skip to main content The Future of Prostate Cancer Treatment: Why 5 Days is the New Standard Clinical Insights • October 12, 2023 For decades, treating prostate cancer with radiation required daily visits for up to 9 weeks. With the advent of adaptive SBRT, patients are returning to their normal lives in just 5 days. This article is part of the 5D Cancer Services educational resource on adaptive radiotherapy. Visit our full library for more insights on precision radiation oncology. ## Understanding Hypofractionation: Doing More with Less URL: https://www.5dcancerservices.com/blog/understanding-hypofractionation Skip to main content Understanding Hypofractionation: Doing More with Less Education • November 04, 2023 What exactly does hypofractionation mean, and why is extreme precision required to make it safe? A deep dive into radiation biology. This article is part of the 5D Cancer Services educational resource on adaptive radiotherapy. Visit our full library for more insights on precision radiation oncology. ## Online vs. Offline Adaptive Therapy: What's the Difference? URL: https://www.5dcancerservices.com/blog/online-vs-offline-adaptive Skip to main content Online vs. Offline Adaptive Therapy: What's the Difference? Technology • December 18, 2023 Many centers claim to offer adaptive therapy, but not all adaptation is created equal. Understanding the vital difference between real-time and delayed re-planning. This article is part of the 5D Cancer Services educational resource on adaptive radiotherapy. Visit our full library for more insights on precision radiation oncology. ## Protecting the Rectum and Bladder: Reducing GI/GU Toxicity URL: https://www.5dcancerservices.com/blog/reducing-side-effects-gi-gu Skip to main content Protecting the Rectum and Bladder: Reducing GI/GU Toxicity Patient Care • January 22, 2024 How daily anatomical tracking allows us to actively bend the radiation dose away from sensitive pelvic organs during treatment. This article is part of the 5D Cancer Services educational resource on adaptive radiotherapy. Visit our full library for more insights on precision radiation oncology. ## Contact Us URL: https://www.5dcancerservices.com/contact Skip to main content Contact & Consultations We are here to help you navigate your diagnosis. Our team is ready to answer your questions and evaluate if adaptive radiotherapy is right for you. Call Us Phone: (435) 900-7060 Hours of Operation Monday – Friday: 8:00 AM – 5:00 PM Saturday – Sunday: Closed St. George, UT Southern Utah, St. George, UT Important: Please do not send Protected Health Information (PHI) by email or voicemail. To protect your privacy, please call us directly.