title: The role of [(18)F]FDG-PET/CT in staging and treatment planning for volumetric modulated Rapidarc radiotherapy in cervical cancer: experience of the European Institute of Oncology, Milan, Italy.
abstract: BACKGROUND
  to evaluate the role of 18F-fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) integrated with computer tomography (CT) scan [(18)F]FDG-PET/CT in the staging and target volume definition in Intensity Modulated RapidarcTM Delivery (RA-IMRT) in cervical cancer.
  
  
  METHODS
  From June 2010 to December 2011, 66 patients affected by cervical cancer, candidates for definitive or adjuvant radiochemotherapy, underwent standard staging with CT and magnetic resonance imaging (MRI). All patients underwent [(18)F]FDG-PET/CT in order to exclude distant metastases and to define gross tumor volume (GTV). 40 and 26 patients received exclusive and adjuvant radiotherapy, respectively. RA-IMRT with simultaneous integrated boost (SIB) to the positive disease technique was employed.
  
  
  RESULTS
  [(18)F]FDG-PET/CT has changed the stage, and radiotherapy treatment planning was modified in 25% and 7.7 % of patients that received definitive and adjuvant radiotherapy, respectively. Particularly [(18)F]FDG-PET/CT imaging showed metabolically active tumor in lymph nodes area, therefore the stage and the treatment planning changed for these patients.
  
  
  CONCLUSIONS
  [(18)F]FDG-PET/CT leads to a better staging and definition of disease and has the potential of showing lymph-node metastasis not only within the pelvis but also in the para-aortic area. In addition, [(18)F]FDG-PET/CT is useful for better definition of the target volume and to produce a 'dose painted' treatment. This might also open the field for escalation dose regimens.
authors.affiliation: Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lazzari
authors.affiliation: Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Cecconi
authors.affiliation: Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy ; University of Milan, Milan 20122, Italy.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.affiliation: Department of Nuclear Medicine, European Institute of Oncology, Milan 20141, Italy.
authors.forename: Laura Lavinia
authors.initials: LL
authors.lastname: Travaini
authors.affiliation: Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Dell' Acqua
authors.affiliation: Medical Physics Division, European Institute of Oncology, Milan 20141, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cattani
authors.affiliation: Radiology Division, European Institute of Oncology, Milan 20141, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rizzo
authors.affiliation: Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Fodor
authors.affiliation: Cervical Cancer Centre, Division of Gynaecologic Cancer Surgery, European Institute of Oncology, Milan 20141, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Landoni
authors.affiliation: Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy ; University of Milan, Milan 20122, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
keywords: ([18F]FDG-PET/CT); IMRT; Rapidarc radiotherapy; cervical cancer