{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T10:11:10Z","timestamp":1776852670610,"version":"3.51.2"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T00:00:00Z","timestamp":1707264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"VARIAN"},{"name":"Dieter Morszeck Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: External beam radiotherapy (EBRT) and concurrent chemotherapy, followed by brachytherapy (BT), offer a standard of care for patients with locally advanced cervical carcinoma. Conventionally, large safety margins are required to compensate for organ movement, potentially increasing toxicity. Lately, daily high-quality cone beam CT (CBCT)-guided adaptive radiotherapy, aided by artificial intelligence (AI), became clinically available. Thus, online treatment plans can be adapted to the current position of the tumor and the adjacent organs at risk (OAR), while the patient is lying on the treatment couch. We sought to evaluate the potential of this new technology, including a weekly shuttle-based 3T-MRI scan in various treatment positions for tumor evaluation and for decreasing treatment-related side effects. (2) Methods: This is a prospective one-armed phase-II trial consisting of 40 patients with cervical carcinoma (FIGO IB-IIIC1) with an age \u2265 18 years and a Karnofsky performance score \u2265 70%. EBRT (45\u201350.4 Gy in 25\u201328 fractions with 55.0\u201358.8 Gy simultaneous integrated boosts to lymph node metastases) will be accompanied by weekly shuttle-based MRIs. Concurrent platinum-based chemotherapy will be given, followed by 28 Gy of BT (four fractions). The primary endpoint will be the occurrence of overall early bowel and bladder toxicity CTCAE grade 2 or higher (CTCAE v5.0). Secondary outcomes include clinical feasibility, quality of life, and imaging-based response assessment.<\/jats:p>","DOI":"10.3390\/jcm13040957","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T08:28:16Z","timestamp":1707294496000},"page":"957","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1731-7090","authenticated-orcid":false,"given":"Fabian","family":"Weykamp","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7087-9581","authenticated-orcid":false,"given":"Eva","family":"Meixner","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2389-5404","authenticated-orcid":false,"given":"Nathalie","family":"Arians","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Hoegen-Sa\u00dfmannshausen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0775-8565","authenticated-orcid":false,"given":"Ji-Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bouchra","family":"Tawk","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"},{"name":"Division of Molecular and Translational Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Knoll","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"},{"name":"Division of Molecular and Translational Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Huber","sequence":"additional","affiliation":[{"name":"Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laila","family":"K\u00f6nig","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anja","family":"Sander","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa","family":"Mokry","sequence":"additional","affiliation":[{"name":"Department of Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara","family":"Meinzer","sequence":"additional","affiliation":[{"name":"Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinz-Peter","family":"Schlemmer","sequence":"additional","affiliation":[{"name":"Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"J\u00e4kel","sequence":"additional","affiliation":[{"name":"Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Debus","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"},{"name":"Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"German Cancer Consortium (DKTK), Partner Site, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliane","family":"H\u00f6rner-Rieber","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, 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Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.radonc.2018.03.003","article-title":"The European Society of Gynaecological Oncology\/European Society for Radiotherapy and Oncology\/European Society of Pathology guidelines for the management of patients with cervical cancer","volume":"127","author":"Cibula","year":"2018","journal-title":"Radiother. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S1470-2045(20)30753-1","article-title":"MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): A multicentre prospective cohort study","volume":"22","author":"Tanderup","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.ijrobp.2015.12.363","article-title":"Health-Related Quality of Life in Locally Advanced Cervical Cancer Patients After Definitive Chemoradiation Therapy Including Image Guided Adaptive Brachytherapy: An Analysis From the EMBRACE Study","volume":"94","author":"Kirchheiner","year":"2016","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1002\/cncr.10248","article-title":"The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients","volume":"94","author":"Bacon","year":"2002","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1016\/j.ejca.2011.11.014","article-title":"Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data","volume":"48","author":"Nout","year":"2012","journal-title":"Eur. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S1470-2045(10)70026-7","article-title":"Defining pelvic-radiation disease for the survivorship era","volume":"11","author":"Andreyev","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.ygyno.2011.12.432","article-title":"Intensity-modulated radiation therapy for advanced cervical cancer: A comparison of dosimetric and clinical outcomes with conventional radiotherapy","volume":"125","author":"Du","year":"2012","journal-title":"Gynecol. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.ijrobp.2013.06.2059","article-title":"Early Clinical Outcomes and Toxicity of Intensity Modulated Versus Conventional Pelvic Radiation Therapy for Locally Advanced Cervix Carcinoma: A Prospective Randomized Study","volume":"87","author":"Gandhi","year":"2013","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2538","DOI":"10.1200\/JCO.2017.77.4273","article-title":"Patient-Reported Toxicity During Pelvic Intensity-Modulated Radiation Therapy: NRG Oncology-RTOG 1203","volume":"36","author":"Klopp","year":"2018","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.clon.2018.08.002","article-title":"The potential value of MRI in external-beam radiotherapy for cervical cancer","volume":"30","author":"Cree","year":"2018","journal-title":"Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.ijrobp.2008.03.064","article-title":"Cervix Regression and Motion During the Course of External Beam Chemoradiation for Cervical Cancer","volume":"73","author":"Beadle","year":"2009","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.semradonc.2019.02.007","article-title":"Adaptive Radiotherapy for Anatomical Changes","volume":"29","author":"Sonke","year":"2019","journal-title":"Semin. Radiat. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13014-019-1308-y","article-title":"MR-guidance in clinical reality: Current treatment challenges and future perspectives","volume":"14","author":"Corradini","year":"2019","journal-title":"Radiat. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5687","DOI":"10.1200\/JCO.2006.07.4799","article-title":"Early invasive cervical cancer: Tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651\/GOG 183 Intergroup Study","volume":"24","author":"Mitchell","year":"2006","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.radonc.2011.12.024","article-title":"Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): Basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy","volume":"103","author":"Dimopoulos","year":"2012","journal-title":"Radiother. Oncol."},{"key":"ref_17","first-page":"216","article-title":"Neue Version der S3-Leitlinie Zervixkarzinom: Empfehlungen f\u00fcr operative Therapien, Radiochemotherapie sowie Rezidiv-und Metastasierungssituation aktualisiert","volume":"44","author":"Hohenhaus","year":"2021","journal-title":"Oncol. Res. Treat."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lee, N.Y., Riaz, N., and Lu, J.J. (2014). Target Volume Delineation for Conformal and Intensity-Modulated Radiation Therapy, Springer.","DOI":"10.1007\/978-3-319-05726-2"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.ijrobp.2009.10.075","article-title":"Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer","volume":"79","author":"Lim","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_20","first-page":"48","article-title":"The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies","volume":"9","author":"Tanderup","year":"2018","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.radonc.2018.05.002","article-title":"Physician assessed and patient reported urinary morbidity after radio-chemotherapy and image guided adaptive brachytherapy for locally advanced cervical cancer","volume":"127","author":"Fokdal","year":"2018","journal-title":"Radiother. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.radonc.2018.05.016","article-title":"Bowel morbidity following radiochemotherapy and image-guided adaptive brachytherapy for cervical cancer: Physician- and patient reported outcome from the EMBRACE study","volume":"127","author":"Jensen","year":"2018","journal-title":"Radiother. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3109\/00365521.2010.545832","article-title":"\u201cPelvic radiation disease\u201d: New understanding and new solutions for a new disease in the era of cancer survivorship","volume":"46","author":"Andreyev","year":"2011","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.phro.2020.12.004","article-title":"Clinical implementation of artificial intelligence-driven cone-beam computed tomography-guided online adaptive radiotherapy in the pelvic region","volume":"17","author":"Sibolt","year":"2021","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e234066","DOI":"10.1001\/jamanetworkopen.2023.4066","article-title":"Comparison of Online-Onboard Adaptive Intensity-Modulated Radiation Therapy or Volumetric-Modulated Arc Radiotherapy With Image-Guided Radiotherapy for Patients With Gynecologic Tumors in Dependence on Fractionation and the Planning Target Volume Margin","volume":"6","author":"Guberina","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_26","first-page":"100596","article-title":"Implementing cone-beam computed tomography-guided online adaptive radiotherapy in cervical cancer","volume":"40","author":"Shelley","year":"2023","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e13783","DOI":"10.1002\/acm2.13783","article-title":"Dosimetric and feasibility evaluation of a CBCT-based daily adaptive radiotherapy protocol for locally advanced cervical cancer","volume":"24","author":"Branco","year":"2023","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Peng, H., Zhang, J., Xu, N., Zhou, Y., Tan, H., and Ren, T. (2023). Fan beam CT-guided online adaptive external radiotherapy of uterine cervical cancer: A dosimetric evaluation. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-11089-6"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"941","DOI":"10.3109\/0284186X.2010.510145","article-title":"Evaluating repetitive 18F-fluoroazomycin-arabinoside (18FAZA) PET in the setting of MRI guided adaptive radiotherapy in cervical cancer","volume":"49","author":"Schuetz","year":"2010","journal-title":"Acta Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40644-015-0037-1","article-title":"Diffusion-weighted imaging and dynamic contrast-enhanced MRI in assessing response and recurrent disease in gynaecological malignancies","volume":"15","author":"Hameeduddin","year":"2015","journal-title":"Cancer Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.ejro.2015.11.003","article-title":"Role of 3T multiparametric-MRI with BOLD hypoxia imaging for diagnosis and post therapy response evaluation of postoperative recurrent cervical cancers","volume":"3","author":"Mahajan","year":"2016","journal-title":"Eur. J. Radiol. Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1016\/j.ejrad.2016.10.011","article-title":"Can diffusion-weighted magnetic resonance imaging predict survival in patients with cervical cancer? A meta-analysis","volume":"85","author":"Wang","year":"2016","journal-title":"Eur. J. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1003930","DOI":"10.3389\/fonc.2022.1003930","article-title":"Post treatment imaging in patients with local advanced cervical carcinoma","volume":"12","author":"Ciulla","year":"2022","journal-title":"Front. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/4\/957\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:56:32Z","timestamp":1760104592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/4\/957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,7]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["jcm13040957"],"URL":"https:\/\/doi.org\/10.3390\/jcm13040957","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,7]]}}}