Radionuclide-Based Theranostic Mapping for Spatially Optimized Treatment Planning in Cervical Carcinoma

Background: Intratumoral heterogeneity in cervical carcinoma may influence absorbed dose distribution, treatment resistance, and response, but is not adequately captured by conventional uniform planning. Methods: A total of 35 patients with histologically confirmed cervical carcinoma underwent baseline theranostic imaging. Voxel-wise tumor uptake was analyzed to derive SUV max , SUV mean , tumor-to-background ratio, coefficient of variation, entropy, and fractional low-, intermediate-, and high-uptake subregions. Voxel-based absorbed dose distributions were estimated, and a dose heterogeneity index was calculated. Conventional uniform planning was compared with theranostic-guided spatial optimization. An integrated theranostic score was developed for response prediction and risk stratification. Results: Nonresponders showed higher uptake intensity, greater spatial heterogeneity, larger high-uptake fractions, and higher integrated theranostic scores than responders. Tumor absorbed dose exceeded that of bladder, rectum, and normal pelvic soft tissue. SUV mean correlated positively with tumor absorbed dose, whereas uptake coefficient of variation correlated with dose heterogeneity. Theranostic-guided spatial optimization improved target coverage, conformity, and high-risk subregion coverage relative to conventional uniform planning. The integrated theranostic score demonstrated strong predictive performance for response classification (area under the receiver operating characteristic curve, 0.95; 95% confidence interval, 0.84–0.98). Conclusions: Radionuclide theranostic mapping provided a quantitative framework linking spatial uptake heterogeneity to dosimetry, planning benefit, and treatment response in cervical carcinoma.