Objective The dose parameters and clinical efficacy of three-dimensional intraluminal post-loading radiotherapy and two-dimensional endoluminal post-loading radiotherapy were compared in patients with locally advanced cervical cancer.? Methods? A total of 180 patients with cervical cancer were included in this study, all from Luohe Central Hospital, and the selected period was from March 2018 to December 2023. According to radiotherapy methods, all patients were divided into two groups (90 cases were given conventional 2D intra translumal radiotherapy) and three groups (90 cases were given 3D intra translumal radiotherapy). The short-term efficacy, radiation dose, serological tumor markers before and after treatment, and the occurrence of acute radiation cystitis and acute radiation proctitis after treatment were compared between the two groups 1 to 3 months after treatment according to MRI and other relevant images of patients. Results The total effective rate of the three-dimensional group was 83.33%, which was higher than that of the two-dimensional group (82.22%) (χ2=0.039, P>0.05). D2cm3, D1cm3 and D0.1cm3 of small intestine, bladder and rectum in 3D group were all decreased compared with those in 2D group. The target coverage index and target conformal index were higher than those of 2D group (t=10.175, 38.279, 12.399, 12.861, 9.019, 9.222, 19.601, 18.247, 12.669, 3.729, 6.548, all P<0.05). There were no statistically significant differences in serum CEA and CA125 indexes between groups before and after treatment (t=0.326 and 0.882, both P>0.05). Serum SCC-Ag indexes between two groups after treatment were lower than before treatment, but no statistically significant differences were found between groups (t=1.017, P>0.05). The incidence of grade I to Ⅲ acute radiation cystitis in the three-dimensional group was significantly lower than that in the two-dimensional group (χ2=3.972, 4.709, 4.709, all P<0.05). The incidence of grade I to II acute radiation proctitis in the three-dimensional group was significantly lower than that in the two-dimensional group (χ2=3.894, 4.490, P<0.05). Conclusion In the treatment of patients with locally advanced cervical cancer, the clinical efficacy of patients with three-dimensional intraperitoneal radiotherapy has been improved to a certain extent. Three-dimensional intraperitoneal radiotherapy can increase the target dose while reducing the dose of rectum and bladder, improve the objective remission rate of tumors, effectively reduce the incidence of adverse reactions, and have good safety.