Abstract: Objective To propose arectal toxicity prediction method based on deformable surface dose accumulation. Methods The clinical data were collected retrospectively from 42patients receiving radiotherapy for cervical cancer. With the first fraction as the reference, the other fractions of rectum surface were registered to the reference fraction to obtain the deformation vector fields (DVFs), which were used to deform and sum the fractional rectal doses to yield the cumulative rectal dose. The cumulative rectal dose was flattened via 3D-2D mapping to generate a 2D rectum surface dose map. Two dosimetric features, namely DVPs and DGPs were extracted. Logistic regression embedded with sequential forward feature selection was used as the prediction model. The predictive performance was evaluated in terms of the accuracy, sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC). Results Significant improvements for rectum surface DIR were achieved. The best predictive results were achieved by using both DVPs and DGPs as the features with a sensitivity of 79.5%, a specificity of 81.3% and an AUC of 0.88. Conclusion The proposed method is feasible for predicting clinical rectal toxicity in patients undergoing radiotherapy for cervical cancer.