Moderately Hypofractionated Online Adaptive Radiotherapy for Cervical Cancer: A Prospective Study of Feasibility, Acute Toxicity and Dosimetric Benefits
In brief
Daily adaptive radiotherapy achieved 99% plan success and 8% better tumor coverage
In 30 cervical cancer patients, online adaptive radiotherapy delivered 510 fractions with a 99% first-attempt success rate and increased uterine and cervical target coverage by about 8% while sparing bladder, rectum and bowel. Acute severe gastrointestinal toxicity occurred in 10% and severe blood toxicity in 40%, but no treatment breaks were needed. Larger studies are needed to confirm safety and long-term outcomes.
- Journal
- Cancers (Q1)
- Published
- 4 August 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Zheng Zeng, Yining Chen, Xiangyin Meng, Yuliang Sun, Junfang Yan, Ke Hu, et al.
- PMID
- 42588709
- DOI
- 10.3390/cancers18152493
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 16 August 2026): Online adaptive hypofractionated radiotherapy for cervical cancer
Abstract
BACKGROUND/OBJECTIVES: Moderately hypofractionated radiotherapy (MHRT) may shorten treatment duration for cervical cancer but raises concerns regarding toxicity due to substantial interfractional pelvic organ motion. This prospective study evaluated the feasibility, workflow efficiency, dosimetric benefits, and acute toxicities of daily online adaptive radiotherapy (oART)-guided MHRT. METHODS: Thirty patients with FIGO 2018 stage IB1-IIB or IIIC1 cervical squamous cell carcinoma receiving definitive chemoradiotherapy were prospectively included between September 2023 and April 2024 (NCT05994300). All patients underwent daily oART, receiving 43.35 Gy in 17 fractions to the pelvic target volume, with a simultaneous integrated boost to 54.40 Gy in 17 fractions for involved lymph nodes. The adaptive workflow consisted of iterative cone-beam computed tomography acquisition, artificial intelligence-assisted contouring, physician review, plan adaptation, and treatment verification. Workflow efficiency, plan selection, target coverage, organ-at-risk (OAR) sparing, treatment completion, early tumor response and acute toxicity were prospectively assessed. RESULTS: A total of 510 adaptive fractions were delivered. The first-attempt adaptation success rate was 99.0%, and adapted plans were selected in 99.4% of fractions. The mean adaptive workflow and total treatment times were 17.3 and 23.3 min per fraction, respectively. Compared with scheduled plans, adapted plans significantly improved target coverage, with V100% increasing by 7.26% for the planning target volume of the uterus and 8.79% for planning target volume of the cervix (both p < 0.001), while significantly reducing doses to the bladder, rectum, small bowel, bone marrow, and femoral heads. All patients achieved complete clinical response at 3 months. Acute toxicity was generally manageable; Grade ≥ 3 gastrointestinal, genitourinary, and hematologic toxicities occurred in 10%, 0%, and 40% of patients, respectively, including one Grade 4 neutropenia event, and no treatment interruptions. CONCLUSIONS: Daily oART-guided MHRT was feasible and efficient, providing improved target coverage and reduced OAR doses compared with scheduled plans. Acute toxicity was acceptable. These findings provide early prospective evidence supporting the feasibility of this treatment strategy and warrant further validation in larger prospective studies with longer follow-up.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.