The overall goal of this project is improved radiotherapy treatment of patients with cervical cancer with use of positron emission tomography (PET). PET with F-18 fluorodeoxyglucose (FDG) will be used to provide three-dimensional definition of the primary tumor volume and regional spread of disease to more accurately administer brachytherapy. PET-based prognostic indicators will be developed. The first step will be verification of the ability of PET to accurately define tumor volume and to differentiate recurrent tumor from radiation-induced inflammation. Tumor size and extent of disease will be correlated with the results of magnetic resonance imaging in patients receiving radiotherapy with evaluation of FDG uptake before, during and after radiotherapy. Techniques will be developed to accurately determine the position of the brachytherapy applicator in relation to the tumor volume. FDG-PET images showing the primary tumor and regional spread of disease will-be spatially registered with the position of the brachytherapy applicator after placement of the applicator in the patient, thus permitting modification of the source loading in the future to optimize the dose to the tumor while minimizing radiation of the adjacent normal structures. The dose to the tumor and normal structures will be evaluated and follow-up will be performed to assess the rate of recurrence and complications in relation to the calculated doses the patients actually received. The potential impact of PET-guided alterations in source loading and treatment duration will be evaluated. To determine the prognostic value of PET, the volume of the primary tumor and the tracer uptake and heterogeneity of uptake within the tumor, obtained from FDG-PET images, will be correlated with the rate of tumor recurrence to determine PET markers that will identify patients at high risk for early recurrence who may need more aggressive initial treatment.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA085797-03
Application #
6633684
Study Section
Diagnostic Radiology Study Section (RNM)
Program Officer
Farahani, Keyvan
Project Start
2001-04-03
Project End
2005-03-31
Budget Start
2003-04-01
Budget End
2004-03-31
Support Year
3
Fiscal Year
2003
Total Cost
$173,250
Indirect Cost
Name
Washington University
Department
Radiation-Diagnostic/Oncology
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Schwarz, Julie K; Lin, Lillie L; Siegel, Barry A et al. (2008) 18-F-fluorodeoxyglucose-positron emission tomography evaluation of early metabolic response during radiation therapy for cervical cancer. Int J Radiat Oncol Biol Phys 72:1502-7
Lin, Lilie L; Mutic, Sasa; Low, Daniel A et al. (2007) Adaptive brachytherapy treatment planning for cervical cancer using FDG-PET. Int J Radiat Oncol Biol Phys 67:91-6
Xue, Feiyu; Lin, Lilie L; Dehdashti, Farrokh et al. (2006) F-18 fluorodeoxyglucose uptake in primary cervical cancer as an indicator of prognosis after radiation therapy. Gynecol Oncol 101:147-51
Lin, Lilie L; Mutic, Sasa; Malyapa, Robert S et al. (2005) Sequential FDG-PET brachytherapy treatment planning in carcinoma of the cervix. Int J Radiat Oncol Biol Phys 63:1494-501
Esthappan, Jacqueline; Mutic, Sasa; Malyapa, Robert S et al. (2004) Treatment planning guidelines regarding the use of CT/PET-guided IMRT for cervical carcinoma with positive paraaortic lymph nodes. Int J Radiat Oncol Biol Phys 58:1289-97
Wahab, Sasha H; Malyapa, Robert S; Mutic, Sasa et al. (2004) A treatment planning study comparing HDR and AGIMRT for cervical cancer. Med Phys 31:734-43
Miller, Tom R; Pinkus, Edward; Dehdashti, Farrokh et al. (2003) Improved prognostic value of 18F-FDG PET using a simple visual analysis of tumor characteristics in patients with cervical cancer. J Nucl Med 44:192-7
Mutic, Sasa; Malyapa, Robert S; Grigsby, Perry W et al. (2003) PET-guided IMRT for cervical carcinoma with positive para-aortic lymph nodes-a dose-escalation treatment planning study. Int J Radiat Oncol Biol Phys 55:28-35
Miller, Tom R; Grigsby, Perry W (2002) Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated by radiation therapy. Int J Radiat Oncol Biol Phys 53:353-9
Malyapa, Robert S; Mutic, Sasa; Low, Daniel A et al. (2002) Physiologic FDG-PET three-dimensional brachytherapy treatment planning for cervical cancer. Int J Radiat Oncol Biol Phys 54:1140-6

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