Wang GY, Chen YN, Sun S, Hu K. Online adaptive radiotherapy enhances precision and outcomes in the treatment of cervical cancer. World J Clin Oncol 2026; 17(3): 116673 [DOI: 10.5306/wjco.v17.i3.116673]
Corresponding Author of This Article
Shuai Sun, MD, Professor, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. sunshuai@pumch.cn
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Oncology
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Minireviews
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Mar 24, 2026 (publication date) through Mar 26, 2026
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World Journal of Clinical Oncology
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2218-4333
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Wang GY, Chen YN, Sun S, Hu K. Online adaptive radiotherapy enhances precision and outcomes in the treatment of cervical cancer. World J Clin Oncol 2026; 17(3): 116673 [DOI: 10.5306/wjco.v17.i3.116673]
World J Clin Oncol. Mar 24, 2026; 17(3): 116673 Published online Mar 24, 2026. doi: 10.5306/wjco.v17.i3.116673
Online adaptive radiotherapy enhances precision and outcomes in the treatment of cervical cancer
Guang-Yu Wang, Yi-Ning Chen, Shuai Sun, Ke Hu
Guang-Yu Wang, Yi-Ning Chen, Shuai Sun, Ke Hu, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Co-first authors: Guang-Yu Wang and Yi-Ning Chen.
Co-corresponding authors: Shuai Sun and Ke Hu.
Author contributions: Wang GY and Chen YN conducted the literature search, data extraction, evidence synthesis, and manuscript drafting, and they contributed equally to this work as co-first authors; Sun S and Hu K supervised the study, provided critical revision of the manuscript and ensured the accuracy and integrity of the content, and they contributed equally to this manuscript as co-corresponding authors. All authors have contributed to the manuscript and approved the final version for submission.
Supported by National High Level Hospital Clinical Research Funding, No. 2025-PUMCH-A-027; and National Key R and D Program of China, Ministry of Science and Technology of the People’s Republic of China, No. 2022YFC2402305.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Shuai Sun, MD, Professor, Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. sunshuai@pumch.cn
Received: November 18, 2025 Revised: January 21, 2026 Accepted: February 27, 2026 Published online: March 24, 2026 Processing time: 126 Days and 0.7 Hours
Abstract
Cervical cancer remains a major global health burden, and radiotherapy is central across all disease stages. Interfractional organ motion, tumor regression and setup uncertainty can compromise the accuracy of conventional margin-based radiotherapy. To summarize current evidence on online adaptive radiotherapy (oART) for cervical cancer within a problem-driven readiness framework, this narrative review searched PubMed, EMBASE and Web of Science to identify studies published up to 2025, which were interpreted using an oART readiness framework integrating anatomic complexity, clinical indication, platform suitability, institutional readiness and patient selection. Cervical cancer shows time-dependent target volume changes and patient-specific setup variability, making static planning target volume concepts problematic. On cone beam computed tomography-, fan beam computed tomography- and magnetic resonance imaging-guided platforms, oART enables margin reduction, improves target coverage and reduces bowel and bladder doses. Prospective cohorts report favorable acute toxicity but data on late toxicity and survival remain limited. Emerging studies also suggest that less frequent or trigger-based adaptation may recapture most dosimetric benefits in selected patients. oART is a promising strategy to individualize cervical cancer radiotherapy, but its added value is indication- and resource-dependent. Tiered, readiness-based implementation and prospective trials are needed to define optimal use.
Core Tip: Online adaptive radiotherapy (oART) enables individualized, fraction-by-fraction plan adaptation in cervical cancer, addressing tumor regression, organ motion, and anatomic variability. By integrating daily imaging, automated or artificial intelligence-assisted contouring, and on-table plan re-optimization, oART improves target coverage, enhances dose precision, and effectively spares pelvic organs at risk. Evidence demonstrates that oART can reduce acute treatment-related toxicities and provides a practical framework for workflow optimization and clinical implementation in modern cervical cancer radiotherapy.
