Trial reportJournal of applied clinical medical physics2025
Prospective multi-institutional study of library-based adaptive radiotherapy for cervical cancer: Evaluation of plan-of-the-day selection and population analysis.
Trial report in Journal of applied clinical medical physics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Prospective multi-institutional study of library-based adaptive radiotherapy for cervical cancer: Evaluation of plan-of-the-day selection and population analysis.Journal of applied clinical medical physics · 2025Trial
- Radiomics and artificial intelligence in precision radiotherapy for cervical cancer: a narrative review.Frontiers in oncology · 2026Review
Corrections and comments
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Authors and funding
14 authors.
Funding
Abstract
purposePlan-of-the-day (PoD) adaptive radiation therapy (ART) is based on a library of treatment plans, with 3D daily imaging guiding the plan selection. In a phase II multi-institutional trial of cone-beam CT (CBCT)-guided PoD-ART for locally advanced cervical carcinoma (LACC), this study aimed at evaluating the PoD selection, its geometric and dosimetric impact and characterizing a sub-population of patients associated with dosimetric improvement from ART. MATERIAL AND
methodsFor 49 cervical cancer patients, three planning CT scans [empty bladder (EB), intermediate bladder (IB) and full bladder (FB)] were acquired to generate a treatment plan library. A dose of 45 Gy was prescribed to the planning target volume in 25 fractions. Daily CBCT were acquired to visually select the best plan in the library (Manual-ART strategy). A deep learning model was used to segment daily clinical target volume (CTVt) and organs-at-risk (OAR). Manual-ART was compared to two strategies: (i) "Non-ART" strategy (IB-CT treatment plan only); (ii) PoD-ART strategy selecting the PoD maximizing CTVt coverage ("Cov-ART"). Geometrical and dosimetric coverages of daily CTVt and OAR were assessed. Decision trees were developed to predict the subpopulation of patients associated with dosimetric benefit from PoD-ART.
resultsThe agreement in PoD selection between Manual-ART and Cov-ART was 63.5%. Compared to the Non-ART strategy (D95%-CTV: 43.6 ± 4.1 Gy), PoD-ART significantly increased the dose to the target, with Manual-ART achieving 44.0 ± 3.0 Gy and Cov-ART with 44.1 ± 2.0 Gy. Decision trees using IB-CT plan and first two treatment fractions correctly classified 85.4% and 93.8% of patients as benefiting or not from PoD-ART.
conclusionsIn PoD-ART for LACC, selected treatment plans by the radiation oncologist had 63.5% concordance with treatment plans maximizing target coverage. PoD-ART increased dose to target, without compromising dose to OARs, with the largest benefit observed in a sub-population identifiable after two treatment fractions.
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