A therapy system includes a diagnostic image scanner (12) that acquires a diagnostic image of a target region to be treated. A planning processor (70) is configured to generate a patient specific adaptive radiation therapy plan based on patient specific biomarkers before and during therapy. A first set of patient specific biomarkers is determined then used for the determination of a first normal tissue complication probability (NTCP) model and a first tumor control probability (TCP) model. A radiation therapy device (40) administers a first dose of radiation to the target region with a protocol based on the first NTCP model and the first TCP model. A second set of patient specific biomarkers is determined. A relationship between the first set and second set of patient specific biomarkers is used to determine a second NTCP model and a second TCP model. The radiation therapy device (40) administers a second dose of radiation to the target region with a protocol based on the second NTCP model and second TCP model.