A Prospective Evaluation of FDG PET Adapted

IMRT/VMAT for Node Positive GYN Cancers

Junzo Chino MD, Irina Vergalasova PhD, Jeff Nawrocki BS, and Oana Craciunescu PhD

Trial Design• Prospective Single Arm• Enrolled Cervical, Uterine, Vulvar Cancers

• This Poster Report Early results of Node Positive Patients

• PET-CT immediately prior to treatment• Definitive Treatment Planned

• 45-50Gy to elective volume• 55-70Gy to PET + Nodes

• Intratreatment PET-CT obtained at 30-36Gy• All Patients replanned

• Only Volumes changed, total dose was kept constant• Brachy used to boost residual central disease

Initial Results• 16 enrolled: 10 Cervix, 4 Uterine, 2 Vulvar• Interim PET Response: • 3 Minimal, 11 Partial, 2 Complete

• Doses to all OAR examined reduced with adapted plans• Bowel Dose was clinically significant

• Median D2cc 55.4 reduced to 52.6

• Women with PA nodal involvement had larger reductions in Dose• No associations with Response or Primary site

Conclusions

• Interim PET based Adaptive planning feasible and is associated with reduced dose to OAR.• Accrual Ongoing with attention to patterns of

failure and toxicity• Next generation protocol: Dose adaptation based

on interim response