{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T21:15:07Z","timestamp":1788297307685,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study aims to investigate the feasibility of fan-beam computed tomography (FBCT)-guided online adaptive radiotherapy (oART) in radical radiotherapy for cervical cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ten patients who underwent radical radiotherapy for cervical cancer were enrolled in this study. All patients received external beam radiation therapy (EBRT) with a prescription dose of 50.4 Gy\/28f, and daily oART with FBCT guidance was performed. Dosimetric analysis was conducted on 278 fractions, comparing the adaptive and scheduled plans. The \u03b3 passing rate was measured through <jats:italic>in-vivo<\/jats:italic> dose monitoring during treatment, using a 3%\/3mm gamma criterion with an 88% threshold for alerts. The time invested in the oART workflow was recorded at each step. Acute toxicities were classified following the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The adaptive plans demonstrated a dosimetric advantage in target coverage and\/or organs at risk (OARs) sparing across all 278 fractions. Compared to the scheduled plan, the adaptive plan showed improved dose received by 95% (D95) of planning target volume (PTV), conformity index (CI), and homogeneity index (HI) (P&amp;lt;0.001). Among the three PTVs, the PTV of uterus (PTV_U) benefited most from dosimetric improvements in the adaptive plan, followed by the PTV of cervix, vagina, and parametrial tissues (PTV_C), while the PTV of lymph node (PTV_N) exhibited the least enhancement. For OARs, the adaptive plan achieved reductions in the dose to the most irradiated 2 cm\u00b3 volume (D2cc) for the rectum, bladder, and small intestine (P&amp;lt;0.001). For patients with ovarian conservation, the dose to the 50% volume (D50) and the mean dose of the bilateral ovaries were decreased (P&amp;lt;0.001). The mean \u03b3 passing rate across all fractions was 99.24%. The mean duration of the oART workflow was 22.82 \u00b1 3.61 min, with auto-segmentation &amp;amp; review (44.40%) and plan generation &amp;amp; evaluation (22.02%) being the most time-intensive steps. The incidence of Grade 1-2 acute non-hematological toxicity was 60%, with no cases of Grade 3 or higher observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The implementation of FBCT-guided oART in radical radiotherapy for cervical cancer was feasible. This approach has shown significant improvements in dose distribution and the potential to provide clinical benefits by reducing acute toxicity.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1509619","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T09:28:01Z","timestamp":1742549281000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Evaluating the Implementation of fan-beam CT-guided online adaptive re-planning in definitive cervical cancer 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