{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:23:19Z","timestamp":1786980199355,"version":"build-2736575974"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100018778","name":"Al-Azhar University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018778","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cancer Res Clin Oncol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-dose-rate (HDR) brachytherapy is essential in the treatment of locally advanced cervical cancer. While Iridium-192 (Ir-192) is commonly used, its short half-life imposes logistical and financial constraints, particularly in low- and middle-income countries (LMICs). Cobalt-60 (Co-60), with a longer half-life and lower operational costs, is a viable alternative. This study aims to evaluate the dosimetric performance and planning uncertainties associated with Co-60 HDR brachytherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective dosimetric analysis was conducted on 30 patients with FIGO stage IIB\u2013IIIB cervical cancer, eligable for Brachytherapy, were treated using CT-guided intracavitary HDR brachytherapy with Co-60 sources. Treatment plans were assessed for high-risk clinical target volume (HR-CTV) coverage (D90, D80), dose-volume histogram parameters, and organ-at-risk (OAR) doses (D2cc for bladder, rectum, and sigmoid). Plan quality indices including conformity index (COIN), dose homogeneity index (DHI), and dose non-uniformity ratio (DNR) were calculated. Uncertainty analyses accounted for treatment planning system (TPS) variability and applicator positioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean HR-CTV D90 was 6.97\u00a0Gy, achieving 99.6% of the prescription dose. The mean D2cc values were 5.73 Gy for bladder (81.9%Rx), 4.72 Gy for rectum (67.4%Rx), and 3.23\u00a0Gy for sigmoid, all within acceptable tolerance limits. The mean COIN was 0.292, DHI 0.31, and DNR 0.69, indicating moderate dose conformity and acceptable inhomogeneity. TPS and applicator uncertainties contributed to estimated dose deviations of\u2009\u00b1\u20092% and\u2009\u00b1\u20091\u00a0mm, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cobalt-60 HDR brachytherapy provides clinically acceptable dose coverage and OAR sparing, with dosimetric outcomes comparable to Ir-192. Its longer half-life offers practical advantages for LMICs. Optimization of dose distribution and further validation through Monte Carlo simulations and prospective clinical studies are recommended.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00432-025-06280-0","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T04:46:12Z","timestamp":1757393172000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dosimetry evaluation and uncertainty analysis of Cobalt-60 HDR brachytherapy for cervical cancer in resource-limited settings"],"prefix":"10.1007","volume":"151","author":[{"given":"Asmaa","family":"M. El-Doushy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehab Marouf","family":"Attalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. H.","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. M.","family":"El-Sayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5940-0565","authenticated-orcid":false,"given":"Ayat M.","family":"Saadeldin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"issue":"5","key":"6280_CR1","doi-asserted-by":"publisher","DOI":"10.1088\/2057-1976\/ac1c52","volume":"7","author":"M Abtahi","year":"2021","unstructured":"Abtahi M, Gholami S, Nashi HHJ (2021) High dose rate 192Ir versus high dose rate 60Co brachytherapy: an overview of systematic reviews of clinical responses of gynecological cancers from 1984 to 2020. Biomed Phys Eng Express 7(5):055022. https:\/\/doi.org\/10.1088\/2057-1976\/ac1c52","journal-title":"Biomed Phys Eng Express"},{"issue":"3","key":"6280_CR2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229\u2013263. https:\/\/doi.org\/10.3322\/caac.21834","journal-title":"CA Cancer J Clin"},{"key":"6280_CR13","doi-asserted-by":"publisher","unstructured":"Chen J, Liu K, Huang P, Wang S (2025) Artificial intelligence in high-dose-rate brachytherapy treatment planning for cervical cancer: a review. Front Oncol 15:1507592. https:\/\/doi.org\/10.3389\/fonc.2025.1507592","DOI":"10.3389\/fonc.2025.1507592"},{"key":"6280_CR3","doi-asserted-by":"publisher","unstructured":"Gao Y, Wang X, Zhang L, Chen M (2024) A review of artificial intelligence in brachytherapy treatment planning. Front Oncol 14:11469420. https:\/\/doi.org\/10.3389\/fonc.2024.1146942","DOI":"10.3389\/fonc.2024.1146942"},{"key":"6280_CR4","unstructured":"GYN GEC ESTRO Working Group (2005) Recommendations for image-based intracavitary brachytherapy of cervix cancer: the GYN GEC ESTRO Working Group point of view: in regard to Nag et al. Int J Radiat Oncol Biol Phys 62:1523\u20131529"},{"key":"6280_CR5","unstructured":"Ian Z, Hasan Y, Yang X et al (2024) Automated treatment planning for interstitial HDR brachytherapy using reinforcement learning. arXiv preprint arXiv:2506.11957."},{"key":"6280_CR6","doi-asserted-by":"crossref","unstructured":"Lim Y, Kim D (2021) Brachytherapy: a comprehensive review. Available from: https:\/\/synapse.koreamed.org\/articles\/1147261","DOI":"10.14316\/pmp.2021.32.2.25"},{"issue":"4","key":"6280_CR7","doi-asserted-by":"publisher","first-page":"232","DOI":"10.5114\/jcb.2012.32558","volume":"4","author":"AL Palmer","year":"2012","unstructured":"Palmer AL, Bidmead M, Nisbet A (2012) A survey of quality control practices for high dose rate (HDR) and pulsed dose rate (PDR) brachytherapy in the United Kingdom. J Contemp Brachyther 4(4):232\u2013237","journal-title":"J Contemp Brachyther"},{"key":"6280_CR05","doi-asserted-by":"publisher","unstructured":"P\u00f6tter R, Haie-Meder C, Van Limbergen E, Barillot I, De Brabandere M, Dimopoulos J et al (2006) Recommendations from Gynaecological (GYN) GEC ESTRO Working Group (I): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy. Radiother Oncol 78(1):67\u201377. https:\/\/doi.org\/10.1016\/j.radonc.2005.12.014","DOI":"10.1016\/j.radonc.2005.12.014"},{"issue":"4","key":"6280_CR8","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/S1470-2045(20)30753-1","volume":"22","author":"R P\u00f6tter","year":"2021","unstructured":"P\u00f6tter R, Tanderup K, Schmid MP, J\u00fcrgenliemk-Schulz I, Haie-Meder C, Fokdal LU et al (2021) MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. Lancet Oncol 22(4):538\u2013547. https:\/\/doi.org\/10.1016\/S1470-2045(20)30753-1","journal-title":"Lancet Oncol"},{"issue":"5","key":"6280_CR9","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1016\/j.ijrobp.2017.09.008","volume":"99","author":"M Randall","year":"2017","unstructured":"Randall M, Filiaci J, McMeekin J, von Gruenigen H, Huang D, Yashar J et al (2017) A phase 3 trial of pelvic radiation therapy versus vaginal cuff brachytherapy followed by paclitaxel\/carboplatin chemotherapy in patients with high-risk, early stage endometrial cancer: a gynecology oncology group study. Int J Radiat Oncol Biol Phys 99(5):1313\u20131321. https:\/\/doi.org\/10.1016\/j.ijrobp.2017.09.008","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"6280_CR10","doi-asserted-by":"crossref","unstructured":"Richter J, Baier K, Flentje M (2008) Comparison of 60cobalt and 192iridium sources in high dose rate afterloading brachytherapy. Strahlenther Onkol. Available from: https:\/\/search.proquest.com\/openview\/36814a590c2cc8be797febeddc268968\/1?pq-origsite=gscholar&cbl=54006","DOI":"10.1007\/s00066-008-1684-y"},{"issue":"15","key":"6280_CR11","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1056\/nejm199904153401502","volume":"340","author":"PG Rose","year":"1999","unstructured":"Rose PG, Bundy ME, Watkins LS, Thigpen W, Deppe J, Maiman M (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340(15):1144\u20131153. https:\/\/doi.org\/10.1056\/nejm199904153401502","journal-title":"N Engl J Med"},{"issue":"9","key":"6280_CR12","doi-asserted-by":"publisher","first-page":"4426","DOI":"10.1002\/mp.12335","volume":"44","author":"H Safigholi","year":"2017","unstructured":"Safigholi H, Meigooni AS, Song WY (2017) Comparison of 192Ir, 169Yb, and 60Co high-dose rate brachytherapy sources for skin cancer treatment. Med Phys 44(9):4426\u20134436. https:\/\/doi.org\/10.1002\/mp.12335","journal-title":"Med Phys"},{"key":"6280_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.radphyschem.2022.110148","volume":"196","author":"S Srivastava","year":"2022","unstructured":"Srivastava S, Singh N, Varghese M (2022) Determination of variation in dosimetric parameters of treatment planning with Co-60 and Ir-192 sources in high dose rate brachytherapy of cervical carcinoma. Radiat Phys Chem 196:110148","journal-title":"Radiat Phys Chem"},{"issue":"4","key":"6280_CR16","doi-asserted-by":"publisher","first-page":"199","DOI":"10.5114\/jcb.2011.26471","volume":"3","author":"S Strohmaier","year":"2011","unstructured":"Strohmaier S, Zwierzchowski G (2011) Comparison of 60Co and 192Ir sources in HDR brachytherapy. J Contemp Brachyther 3(4):199\u2013208. https:\/\/doi.org\/10.5114\/jcb.2011.26471","journal-title":"J Contemp Brachyther"},{"issue":"3","key":"6280_CR17","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209\u2013249. https:\/\/doi.org\/10.3322\/caac.21660","journal-title":"CA Cancer J Clin"},{"issue":"6","key":"6280_CR18","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1080\/0284186X.2022.2068968","volume":"61","author":"J Tamihardja","year":"2022","unstructured":"Tamihardja J, Strittmatter J, M\u00fcller C, Gross MW, Kimmig CP (2022) Comparing Iridium-192 with Cobalt-60 sources in high-dose-rate brachytherapy boost for localized prostate cancer. Acta Oncol 61(6):714\u2013719. https:\/\/doi.org\/10.1080\/0284186X.2022.2068968","journal-title":"Acta Oncol"},{"issue":"5","key":"6280_CR19","doi-asserted-by":"publisher","DOI":"10.3802\/jgo.2018.29.e86","volume":"29","author":"T Tantivatana","year":"2018","unstructured":"Tantivatana T, Rongsriyam K (2018) Treatment outcomes of high-dose-rate intracavitary brachytherapy for cervical cancer: a comparison of Ir-192 versus Co-60 sources. J Gynecol Oncol 29(5):e86. https:\/\/doi.org\/10.3802\/jgo.2018.29.e86","journal-title":"J Gynecol Oncol"},{"issue":"1","key":"6280_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13014-022-02170-8","volume":"17","author":"A Wen","year":"2022","unstructured":"Wen A, Wang L, Liu X, Li Y, Li Y, Wang Y (2022) Radiobiological and dosimetric comparison of 60Co versus 192Ir high-dose-rate intracavitary-interstitial brachytherapy for cervical cancer. Radiat Oncol 17(1):1\u201311. https:\/\/doi.org\/10.1186\/s13014-022-02170-8","journal-title":"Radiat Oncol"},{"issue":"20","key":"6280_CR21","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","volume":"310","author":"World Medical Association","year":"2013","unstructured":"World Medical Association (2013) World Medical Association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310(20):2191\u20132194. https:\/\/doi.org\/10.1001\/jama.2013.281053","journal-title":"JAMA"}],"container-title":["Journal of Cancer Research and Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00432-025-06280-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00432-025-06280-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00432-025-06280-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T08:01:58Z","timestamp":1758787318000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00432-025-06280-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["6280"],"URL":"https:\/\/doi.org\/10.1007\/s00432-025-06280-0","relation":{},"ISSN":["1432-1335"],"issn-type":[{"value":"1432-1335","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]},"assertion":[{"value":"27 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was reviewed and approved by the institutional review board of Al Azhar University (Ethics Committee Reference: IRB-2024-003). Written informed consent was obtained from all patients prior to treatment, and all procedures were conducted in accordance with the ethical standards outlined in the Declaration of Helsinki (2013 revision).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare that there are no conflicts of interest related to this study. No financial, personal, or professional relationships influenced the conduct, analysis, or reporting of the research.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"247"}}