Online adaptive radiotherapy enhances precision and outcomes in the treatment of cervical cancer

Table 1 Comparative characteristics of cone beam computed tomography-, fan beam computed tomography- and magnetic resonance imaging-guided platforms for online adaptive radiotherapy in cervical cancer

Dimension	CBCT-guided	FBCT-guided	MRI-guided
Soft-tissue contrast	Moderate (limited for cervix/uterus boundaries)	Higher than CBCT	Highest (best for cervix/uterus/vagina)
Typical workflow	Fast daily adaptation feasible (routine)	Often mid-course/offline or library-based; can support oART in selected setups	ATP (approximately 30 minutes) to ATS (often approximately 60 minutes) depending on contours/re-optimization
Adaptation depth	Often ATP/Limited ATS	Commonly offline replanning/plan library; selected on-table replanning	True ATS with re-contouring and dose recalculation
Best-fit clinical scenarios	Broad adoption; high throughput; resource-constrained settings	Centers favoring high-quality CT replanning and plan libraries	High-resource centers; complex anatomy; research-heavy practice
Key limitations	Contour uncertainty; CBCT HU/dose calc issues	Less practice in real daily online in many workflows	Time/resource intensive; staffing/QA burden

CBCT: Cone beam computed tomography; FBCT: Fan beam computed tomography; MRI: Magnetic resonance imaging; oART: Online adaptive radiotherapy; ATP: Adapt-to-position; ATS: Adapt-to-shape; HU: Hounsfield unit; CT: Computed tomography; QA: Quality assurance.