Cervical cancer remains a significant global health concern, characterized by high morbidity and mortality rates. High-dose-rate brachytherapy (HDR-BT) is a critical component of cervical cancer treatment, requiring precise and efficient treatment planning. However, the process is labor-intensive, heavily reliant on operator expertise, and prone to variability due to factors such as applicator shifts and organ filling changes. Recent advancements in artificial intelligence (AI), particularly in medical image processing, offer significant potential for automating and standardizing treatment planning in HDR-BT. This review examines the progress and challenge of AI applications in HDR-BT treatment planning, focusing on automatic segmentation, applicator reconstruction, dose calculation, and plan optimization. By addressing current limitations and exploring future directions, this paper aims to guide the integration of AI into clinical practice, ultimately improving treatment accuracy, reducing preparation time, and enhancing patient outcomes.

Radiotherapy is the mainstay of treatment for nasopharyngeal carcinoma. Radiation-induced temporal lobe injury (TLI) can regress or resolve in the early phase, but it is irreversible at a later stage. However, no study has proposed a risk-based follow-up schedule for its early detection. Planning evaluation is difficult when dose-volume histogram (DVH) parameters are similar and optimization is terminated. This multicenter retrospective study included 6065 patients between 2014 and 2018. A 3D ResNet-based deep learning model was developed in training and validation cohorts and independently tested using concordance index in internal and external test cohorts. Accordingly, the patients were stratified into risk groups, and the model-predicted risks were used to develop risk-based follow-up schedules. The schedule was compared with the Radiation Therapy Oncology Group (RTOG) recommendation (every 3 months during the first 2 years and every 6 months in 3–5 years). Additionally, the model was used to evaluate plans with similar DVH parameters. Our model achieved concordance indexes of 0.831, 0.818, and 0.804, respectively, which outperformed conventional prediction models (all P < 0.001). The temporal lobes in all the cohorts were stratified into three groups with discrepant TLI-free survival. Personalized follow-up schedules developed for each risk group could detect TLI 1.9 months earlier than the RTOG recommendation. According to a higher median predicted 3-year TLI-free survival (99.25% vs. 99.15%, P < 0.001), the model identified a better plan than previous models. The deep learning model predicted TLI more precisely. The model-determined risk-based follow-up schedule detected the TLI earlier. The planning evaluation was refined because the model identified a better plan with a lower risk of TLI. The 10.13039/501100002402 Sun Yat-sen University Clinical Research 5010 Program (2015020), 10.13039/501100021171 Guangdong Basic and Applied Basic Research Foundation (2022A1515110356), Medical Scientific Research Foundation of Guangdong Province (A2022367), and Guangzhou Science and Technology Program (2023A04J1788).

To guide individualized intensity-modulated radiotherapy (IMRT), we developed and prospectively validated a multiview radiomics risk model for predicting radiation-induced hypothyroidism in patients with nasopharyngeal carcinoma. And simulated radiotherapy plans with same dose-volume-histogram (DVH) but different dose distributions were redesigned to explore the clinical application of the multiview radiomics risk model. The radiomics and dosiomics were built based on selected radiomics and dosiomics features from planning computed tomography and dose distribution, respectively. The multiview radiomics risk model that integrated radiomics, dosiomics, DVH parameters, and clinical factors had better performance than traditional normal tissue complication probability models. And multiview radiomics risk model could identify differences of patient hypothyroidism-free survival that cannot be stratified by traditional models. Besides, two redesigned simulated plans further verified the clinical application and advantage of the multiview radiomics risk model. The multiview radiomics risk model was a promising method to predict radiation-induced hypothyroidism and guide individualized IMRT.

Early prediction of lymph node metastasis (LNM) following neoadjuvant therapy (NAT) is crucial for timely treatment optimization in esophageal squamous cell carcinoma (ESCC). This study developed and validated a computed tomography-based radiomic model for predicting pathologically confirmed LNM status at the time of surgery in ESCC patients after NAT. A total of 469 ESCC patients from Sun Yat-sen University Cancer Center were retrospectively enrolled and randomized into a training cohort (n = 328) and a test cohort (n = 141). Three signatures were constructed: the tumor-habitat-based signature (Habitat_Rad), derived from radiomic features of three tumor subregions identified via K-means clustering; the multiple instance learning-based signature (MIL_Rad), combining features from 2.5D deep learning models; and the clinicoradiological signature (Clinic), developed through multivariate logistic regression. A combined radiomic nomogram integrating these signatures outperformed the individual models, achieving areas under the curve (AUCs) of 0.929 (95% CI, 0.901–0.957) and 0.852 (95% CI, 0.778–0.925) in the training and test cohorts, respectively. The decision curve analysis confirmed a high net clinical benefit, highlighting the nomogram’s potential for accurate LNM prediction after NAT and guiding individualized therapy.

Explicit standards for buildup-bolus applications in post-mastectomy radiotherapy remain unclear. This study aimed to perform a dosimetric evaluation of target volumes and organs at risk associated with various buildup-bolus thicknesses and application frequencies to identify the optimal buildup-bolus regimen. Thirty-eight post-mastectomy patients were randomly selected between 2017 and 2024. Four sets of simulated treatment plans were created using virtual buildup-boluses with different protocols: daily 3-mm-thick, daily 5-mm-thick, half-time 5-mm-thick, and half-time 10-mm-thick. Cumulative dose-volume histograms were generated for each buildup-bolus regimen to assess dosimetric differences in target volumes and organs at risk. Equivalent uniform dose and normal tissue complication probability were evaluated for the skin. In terms of target volumes, the daily 5-mm-thick buildup-bolus regimen could reduce hot-spot doses while ensuring adequate target dose coverage, and improved dose homogeneity and conformity; For organs at risk, it could deliver necessary chest wall dose while minimizing high-dose exposure to the skin. Radiobiological evaluation of the skin indicated that the daily 5-mm-thick buildup-bolus regimen could reduce recurrence risk. Additionally, this regimen required the fewest monitor units, thereby reducing treatment time and alleviating machine wear and tear. It is concluded that the daily 5-mm-thick buildup-bolus regimen represented the optimal balance for target coverage and chest-wall skin sparing. These findings provide clinical guidance for treatment planning in post-mastectomy radiotherapy.