{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:15:04Z","timestamp":1788257704741,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Med Imag Rad Onc"],"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Offline adaptive replanning is an appealing strategy in cervical cancer external beam radiotherapy (EBRT) to account for tumour shrinkage. It remains unclear whether volume reduction with adaptation improves geometric coverage in the presence of daily pelvic variation. This study evaluated the volumetric and geometric impact of offline EBRT adaptation in this setting.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Seventeen patients who completed definitive radio(chemo)therapy and brachytherapy were retrospectively assessed. An MRI in the last 2\u2009weeks of EBRT was used to generate adaptive targets and organs at risk, which were compared with original volumes for changes in gross tumour volume (GTV), internal target volume (ITV) and planning target volume (PTV). Geometric coverage by the low\u2010risk ITV (ITV\u2010T\u2010LR) and PTV was assessed on 128 cone\u2010beam CTs.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean GTV regressed by 47.9% (\n p<\/jats:italic>\n \u2009=\u20090.0101), corresponding to a 24.2% reduction in ITV\u2010T\u2010LR (\n p<\/jats:italic>\n \u2009=\u20090.0038) and a 10% reduction in PTV (\n p<\/jats:italic>\n \u2009=\u20090.0011). Despite this, offline adaptation reduced ITV\u2010T\u2010LR coverage from 75% with the original volumes to 59% (\n p<\/jats:italic>\n \u2009=\u20090.024). A 5\u2009mm PTV margin increased coverage to 96% for the original plan and 77% for the adapted plan. On multivariable analysis, each 1% increase in on\u2010treatment bladder volume relative to simulation was associated with a 1.3% increase in odds of anterior ITV\u2010T\u2010LR coverage (\n p<\/jats:italic>\n \u2009=\u20090.0279) but a 0.7% decrease in odds of posterior coverage (\n p<\/jats:italic>\n \u2009=\u20090.0017).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The offline adaptation approach used in this study reduced tumour and target volumes for this patient cohort, but worsened geometric target coverage, failing to compensate for daily pelvic anatomical variation. These findings raise concerns about the suitability of offline adaptation for cervical cancer EBRT.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1754-9485.70171","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T09:31:51Z","timestamp":1788255111000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Volumetric and Geometric Assessment of Offline\u00a0Adaptation in Cervical Cancer External\u00a0Beam Radiotherapy"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1442-4086","authenticated-orcid":false,"given":"Pereshin","family":"Moodaley","sequence":"first","affiliation":[{"name":"South Western Sydney Local Health District Cancer Service Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Lim","sequence":"additional","affiliation":[{"name":"South Western Sydney Local Health District Cancer Service Sydney New South Wales Australia"},{"name":"South West Sydney Clinical Campuses University of New South Wales Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viet","family":"Do","sequence":"additional","affiliation":[{"name":"South Western Sydney Local Health District Cancer Service Sydney New South Wales Australia"},{"name":"South West Sydney Clinical Campuses University of New South Wales Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Descallar","sequence":"additional","affiliation":[{"name":"South West Sydney Clinical Campuses University of New South Wales Sydney New South Wales Australia"},{"name":"Ingham Institute of Applied Medical Research Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"issue":"1","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.radonc.2011.07.012","article-title":"Clinical Outcome of Protocol Based Image (MRI) Guided Adaptive Brachytherapy Combined With 3D Conformal Radiotherapy With or Without Chemotherapy in Patients With Locally Advanced Cervical Cancer","volume":"100","author":"P\u00f6tter R.","year":"2011","journal-title":"Radiotherapy and Oncology"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"7179","DOI":"10.2147\/OTT.S178336","article-title":"Dosimetric Comparison of Volumetric\u2010Modulated Arc Therapy and Intensity\u2010Modulated Radiation Therapy in Patients With Cervical Cancer: A Meta\u2010Analysis","volume":"11","author":"Bai W.","year":"2018","journal-title":"OncoTargets and Therapy"},{"issue":"4","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.clon.2013.11.031","article-title":"A Systematic Review of Organ Motion and Image\u2010Guided Strategies in External Beam Radiotherapy for Cervical Cancer","volume":"26","author":"Jadon R.","year":"2014","journal-title":"Clinical Oncology (Royal College of Radiologists)"},{"issue":"12","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.clon.2020.09.010","article-title":"Image\u2010Guided Radiotherapy for Pelvic Cancers: A Review of Current Evidence and Clinical Utilisation","volume":"32","author":"Webster A.","year":"2020","journal-title":"Clinical Oncology (Royal College of Radiologists)"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.ctro.2018.01.001","article-title":"The EMBRACE II Study: The Outcome and Prospect of Two Decades of Evolution Within the GEC\u2010ESTRO GYN Working Group and the EMBRACE Studies","volume":"9","author":"P\u00f6tter R.","year":"2018","journal-title":"Clinical and Translational Radiation Oncology"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.phro.2020.12.004","article-title":"Clinical Implementation of Artificial Intelligence\u2010Driven Cone\u2010Beam Computed Tomography\u2010Guided Online Adaptive Radiotherapy in the Pelvic Region","volume":"17","author":"Sibolt P.","year":"2020","journal-title":"Physics and Imaging in Radiation Oncology"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.radonc.2020.06.017","article-title":"Patterns of Practice for Adaptive and Real\u2010Time Radiation Therapy (POP\u2010ART RT) Part II: Offline and Online Plan Adaption for Interfractional Changes","volume":"153","author":"Bertholet J.","year":"2020","journal-title":"Radiotherapy and Oncology"},{"issue":"1","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/S0360-3016(01)01808-9","article-title":"Method and Timing of Tumor Volume Measurement for Outcome Prediction in Cervical Cancer Using Magnetic Resonance Imaging","volume":"52","author":"Mayr N. 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