A therapy planner (16) is configured to construct a therapy plan based on a planning image segmented into segments delineating features of a subject. A predictive plan adaptation module (20) is configured to adjust the segments to represent a foreseeable change in the subject and to invoke the therapy planner to construct a therapy plan corresponding to the foreseeable change. A data storage (18) stores a plurality of therapy plans generated for a subject by the therapy planner and the predictive plan adaptation module based on at least one planning image of the subject. A therapy plan selector (30) is configured to select one of the plurality of therapy plans for use in a therapy session based on a preparatory image acquired preparatory to the therapy session.