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The re-CT simulation was performed after 15 fractions and a manual adaptive plan was developed if a significant deviation of the planning target volume (PTV) was found. To evaluate the dosimetric benefit, D98, homogeneity index (HI) and conformity index (CI) for the planning target volume (PTV), as well as D2cc of the bowel, bladder, sigmoid and rectum were compared between manual adaptive plans and scheduled ones. The clinical factors influencing target motion during radiotherapy were analyzed by chi-square test and logistic regression analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The CI and HI of the manual adaptive plans were significantly superior to the scheduled ones (<jats:italic>P<\/jats:italic>\u2009=\u20090.0002, 0.003, respectively), demonstrating a better dose coverage of the target volume. Compared to the scheduled plans, D98 of the manual adaptive plans increased by 3.3% (<jats:italic>P<\/jats:italic>\u2009=\u20090.0002), the average of D2cc to the rectum, bladder decreased 0.358\u00a0Gy (<jats:italic>P<\/jats:italic>\u2009=\u20090.000034) and 0.240\u00a0Gy (<jats:italic>P<\/jats:italic>\u2009=\u20090.03), respectively. In addition, the chi-square test demonstrated that age, primary tumor volume, and parametrial infiltration were the clinical factors influencing target motion during radiotherapy. Multivariate analysis further identified the large tumor volume (\u2265\u200950cm<jats:sup>3<\/jats:sup>, OR\u2009=\u20093.254, <jats:italic>P<\/jats:italic>\u2009=\u20090.039) and parametrial infiltration (OR\u2009=\u20093.376, <jats:italic>P<\/jats:italic>\u2009=\u20090.018) as the independent risk factors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>We found the most significant organ motion happened after 15 fractions during treatment. The manual adaptive plans improved the dose coverage and decreased the OAR doses. Patients with bulky mass or with parametrial infiltration were highly suggested to adaptive strategy during definitive radiotherapy due to the significant organ motion.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00432-024-05809-z","type":"journal-article","created":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T18:02:23Z","timestamp":1716832943000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The clinical practice and dosimetric outcome of the manual adaptive planning during definitive radiotherapy for cervical cancer"],"prefix":"10.1007","volume":"150","author":[{"given":"Yi-Wei","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Tong","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao-Ping","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,5,27]]},"reference":[{"key":"5809_CR1","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.ijrobp.2008.03.064","volume":"73","author":"BM Beadle","year":"2009","unstructured":"Beadle BM, Jhingran A, Salehpour M et al (2009) Cervix regression and motion during the course of external beam chemoradiation for cervical cancer. 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