1. 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

2. 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

3. 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

4. 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