{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T15:30:22Z","timestamp":1787153422905,"version":"build-2736575974"},"update-to":[{"DOI":"10.12688\/f1000research.166604.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000}}],"reference-count":18,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5:p>Background Cervical cancer remains to be a significant health concern globally, with India contributing to nearly one-quarter of cases worldwide. Intracavitary brachytherapy (ICBT) combined with external beam radiotherapy (EBRT) is the standard of care, optimizing tumour dose while sparing normal tissues. Plan quality indices such as Dose Homogeneity Index (DHI), Overdose Index (OI), Dose Non-uniformity Ratio (DNR), and Conformity Index (COIN) are crucial in evaluating treatment plans, yet their predictive clinical relevance remains underexplored. Methodology In this Retrospective study, 84 patients with histologically confirmed cervical cancer undergoing definitive chemoradiation followed by CT-based HDR ICBT (Co-60) were evaluated. Plan indices were calculated per ICRU 89 and GEC-ESTRO guidelines. Correlation with tumour response (RECIST v1.1), toxicity (\u2265 grade 2 bladder\/rectal), and clinical factors (FIGO stage, HRCTV volume, EQD2, BED, treatment duration) was assessed using t-tests, regression analyses, and Pearson\u2019s correlation. Results Mean DHI was 0.403; OI 0.358; DNR 0.594; COIN 0.636. Higher DHI (p=0.019) and lower OI (p=0.004) were associated with tumour response; DNR and COIN were not significant. No plan index predicted \u2265 grade 2 bladder or rectal toxicity. COIN correlated poorly with other indices. Multiple regression showed no consistent predictors of dosimetric indices. Logistic regression did not establish any index as a definitive predictor of 3-month response. Conclusion Plan quality indices provide useful quantitative insights into dose distribution in High dose rate intracavitary brachytherapy for cervical cancer. In this study, DHI and OI showed an association with early tumour response, while no significant correlation was observed between plan indices and treatment-related toxicity.<\/ns5:p>","DOI":"10.12688\/f1000research.166604.2","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T15:19:08Z","timestamp":1787152748000},"page":"882","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation and Clinical Relevance of Plan Quality Indices in Intracavitary Brachytherapy for Cervical Cancer"],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9318-7024","authenticated-orcid":false,"given":"Abhishek","family":"Krishna","sequence":"first","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juvie Leona","family":"Lobo","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"MS","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1635-0289","authenticated-orcid":false,"given":"Bharat Sai","family":"Makkapati","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4691-9728","authenticated-orcid":false,"given":"Athiyamaan","family":"MS","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Challapalli","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sourjya","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Sunny","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Simon","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9222-863X","authenticated-orcid":false,"given":"Dilson","family":"Lobo","sequence":"additional","affiliation":[{"name":"Manipal Department of Radiation Oncology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229-263","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"74","author":"F Bray","year":"2024 May cited 2024 Aug 15","journal-title":"Wiley Online Library."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"100296","DOI":"10.1016\/j.lansea.2023.100296","article-title":"Survival of patients with cervical cancer in India \u2013 findings from 11 population based cancer registries under National Cancer Registry Programme.","volume":"24","author":"K Sathishkumar","year":"2024 May 1 cited 2025 Jun 9","journal-title":"The Lancet Regional Health - Southeast Asia."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"293-306","DOI":"10.5114\/jcb.2019.87406","article-title":"Indian Brachytherapy Society Guidelines for radiotherapeutic management of cervical cancer with special emphasis on high-dose-rate brachytherapy.","volume":"11","author":"U Mahantshetty","year":"2019","journal-title":"J. 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We will upload the revised manuscript.  \n<b>Response 2:<\/b> &nbsp;The limitations section has been expanded to acknowledge the relatively short follow-up period, with tumour response assessed at 3 months, as well as the small number of observed toxicity events. We have clarified that these factors limit our ability to draw conclusions regarding long-term clinical outcomes in the revised manuscript.  \n<b>Response 3:<\/b> We have revised the manuscript with respect to language and proof reading. Table 1 has also been reviewed, and the duplicate entry for FIGO stage IVA has been corrected.&nbsp;  \n<b>Response 4:<\/b> The Discussion has been expanded to clarify the clinical relevance of our findings. Although DHI and OI demonstrated significant associations with early tumour response on univariate analysis, these associations were not retained after multivariable adjustment. Therefore, our findings should not be interpreted as establishing DHI or OI as independent predictors of tumour response.","URL":"https:\/\/f1000research.com\/articles\/14-882\/v2#referee-comment-16879","order":2,"name":"referee-comment-16879","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}