title: Adaptive brachytherapy treatment planning for cervical cancer using FDG-PET.
abstract: OBJECTIVE
  A dosimetric study was conducted to compare intracavitary brachytherapy using both a conventional and a custom loading intended to cover a positron emission tomography (PET)-defined tumor volume in patients with cervix cancer.
  
  
  METHODS
  Eleven patients who underwent an [(18)F]-fluoro-deoxy-D-glucose (FDG)-PET in conjunction with their first, middle, or last brachytherapy treatment were included in this prospective study. A standard plan that delivers 6.5 Gy to point A under ideal conditions was compared with an optimized plan designed to conform the 6.5-Gy isodose surface to the PET defined volume.
  
  
  RESULTS
  A total of 31 intracavitary brachytherapy treatments in conjunction with an FDG-PET were performed. The percent coverage of the target isodose surface for the first implant with and without optimization was 73% and 68% (p = 0.21). The percent coverage of the target isodose surface for the mid/final implant was 83% and 70% (p = 0.02), respectively. The dose to point A was higher with the optimized plans for both the first implant (p = 0.02) and the mid/last implants (p = 0.008). The dose to 2 cm(3) and 5 cm(3) of both the bladder and rectum were not significantly different.
  
  
  CONCLUSIONS
  FDG-PET based treatment planning allowed for improved dose coverage of the tumor without significantly increasing the dose to the bladder and rectum.
authors.affiliation: Radiation Oncology Department, Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA.
authors.forename: Lilie L
authors.initials: LL
authors.lastname: Lin
authors.forename: Sasa
authors.initials: S
authors.lastname: Mutic
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Low
authors.forename: Richard
authors.initials: R
authors.lastname: LaForest
authors.forename: Milos
authors.initials: M
authors.lastname: Vicic
authors.forename: Imran
authors.initials: I
authors.lastname: Zoberi
authors.forename: Tom R
authors.initials: TR
authors.lastname: Miller
authors.forename: Perry W
authors.initials: PW
authors.lastname: Grigsby
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18