PURPOSE The optimal neoadjuvant treatment for resectable carcinoma of the thoracic esophagus (TE) or gastroesophageal junction (GEJ) remains a matter of debate. We performed an individual participant data (IPD) network meta-analysis (NMA) of randomized controlled trials (RCTs) to study the effect of chemotherapy or chemoradiotherapy, with a focus on tumor location and histology subgroups. PATIENTS AND METHODS All, published or unpublished, RCTs closed to accrual before December 31, 2015 and having compared at least two of the following strategies were eligible: upfront surgery (S), chemotherapy followed by surgery (CS), and chemoradiotherapy followed by surgery (CRS). All analyses were conducted on IPD obtained from investigators. The primary end point was overall survival (OS). The IPD-NMA was analyzed by a one-step mixed-effect Cox model adjusted for age, sex, tumor location, and histology. The NMA was registered in PROSPERO (CRD42018107158). RESULTS IPD were obtained for 26 of 35 RCTs (4,985 of 5,807 patients) corresponding to 12 comparisons for CS-S, 12 for CRS-S, and four for CRS-CS. CS and CRS led to increased OS when compared with S with hazard ratio (HR) = 0.86 (0.75 to 0.99), P = .03 and HR = 0.77 (0.68 to 0.87), P < .001 respectively. The NMA comparison of CRS versus CS for OS gave a HR of 0.90 (0.74 to 1.09), P = .27 (consistency P = .26, heterogeneity P = .0038). For CS versus S, a larger effect on OS was observed for GEJ versus TE tumors ( P = .036). For the CRS versus S and CRS versus CS, a larger effect on OS was observed for women ( P = .003, .012, respectively). CONCLUSION Neoadjuvant chemotherapy and chemoradiotherapy were consistently better than S alone across histology, but with some variation in the magnitude of treatment effect by sex for CRS and tumor location for CS. A strong OS difference between CS and CRS was not identified.

ResultsTable 1 compares plans generated using differing a-priori information.For ATS plans, there were more PTV_6000 coverage constraint violations (31% vs. 19%) when using more stringent objective values.All mandatory and optimal OAR constraints were satisfied except one optimal, which was likely due to randomness in Monaco's statistical-based optimisation.Neither ten nor five SSO loops demonstrably changed the ATS plans in terms of distributions and DVH values.However, average planning time decreased by 40% (2.6 min) for five loops.

Introduction. During radiotherapy for cervical cancer, anatomical modifications can occur. Daily cone beam CT (CBCT) acquired for positioning issue, could be used to calculate the daily dose. Besides, using a cumulative strategy, it might also allow to calculate the delivered dose during treatment. For this purpose, a CT-CBCT deformable image registration (DIR) is required. The aim of this study was to investigate the quality of DIR for two software.

The development of stereotaxic body radiotherapy in the last decade has forced the radiotherapy departments to redouble their efforts in the fields of quality and risk management. For this purpose, increasingly complex and rigorous controls of high performance machines as well as a solid team training must be put in place. Extreme hypofractionation requires both increased vigilance at the treatment desk and well-defined and known procedures. The in place organizations contribute to the control of the risks related to the stereotaxic body radiotherapy machines. The medical presence at the beginning of the treatment fractions has been specified as mandatory in a regulatory way since January 2017. This not only ensures security, but also transmits information to the radiation therapy technicians. At the Eugene Marquis center, the skills of the technicians for stereotaxic body radiotherapy on two dedicated machines (Cyberknife (R) and Versa HD (R) Novalis (R) type) have been upgraded. An accreditation is formalized after a training period and re-evaluated annually. The communication inside and outside the radiotherapy field plays also an important role in maintaining a high level of exchange and sharing of essential information. The means implemented at the Eugene-Marquis center increase the risk control of SBRT, by paying attention to the management of skills at the treatment station. (C) 2018 Published by Elsevier Masson SAS on behalf of Societe francaise de radiotherapie oncologique (SFRO).

External beam radiotherapy is extensively used to treat cervical carcinomas. A single planning CT scan enables the calculation of the dose distribution. The treatment is delivered over five weeks. Large per-treatment anatomical variations may hamper the dose delivery, with the potential of an organ-at-risk (OAR) overdose and a tumor underdose. To anticipate these deformations, a recent approach proposed three planning CTs with variable bladder volumes, which had the limitation of not covering all per-treatment anatomical variations. An original patient-specific population-based library has been proposed. It consisted of generating two representative anatomies, in addition to the standard planning CT anatomy. First, the cervix and bladder meshes of a population of 20 patients (314 images) were registered to an anatomical template, using a deformable mesh registration. An iterative point-matching algorithm was developed based on local shape context (histogram of polar or cylindrical coordinates and geodesic distance to the base) and on a topology constraint filter. Second, a standard principal component analysis (PCA) model of the cervix and bladder was generated to extract the dominant deformation modes. Finally, specific deformations were obtained using posterior PCA models, with a constraint representing the top of the uterus deformation. For a new patient, the cervix-uterus and bladder were registered to the template, and the patient's modeled planning library was built according to the model deformations. This method was applied following a leave-one-patient-out cross-validation. The performances of the modeled library were compared to those of the three-CT-based library, showing an improvement in both target coverage and OAR sparing.

PurposeIn the context of adaptive radiation therapy (ART) for locally advanced cervical carcinoma (LACC), this study proposed an original cone-beam computed tomography (CBCT)-guided Evolutive library and evaluated it against four other known radiotherapy (RT) strategies. Material and methodsFor 20 patients who underwent intensity-modulated radiation therapy (IMRT) for LACC, three planning CTs [with empty (EB), intermediate (IB), and full (FB) bladder volumes], a CT scan at 20 Gy and bi-weekly CBCTs for 5 weeks were performed. Five RT strategies were simulated for each patient: Standard RT was based on one IB planning CT; internal target volume (ITV)-based RT was an ITV built from the three planning CTs; RT with one mid-treatment replanning (MidTtReplan) corresponded to the standard RT with a replanning at 20 Gy; Pretreatment library ART using a planning library based on the three planning CTs; and the Evolutive library ART, which was the Pretreatment library ART strategy enriched by including some CBCT anatomies into the library when the daily clinical target volume (CTV) shape differed from the ones in the library. Two planning target volume (PTV) margins of 7 and 10 mm were evaluated. All the strategies were geometrically compared in terms of the percentage of coverage by the PTV, for the CTV and the organs at risk (OAR) delineated on the CBCT. Inadequate coverage of the CTV and OARs by the PTV was also assessed using deformable image registration. The cumulated dose distributions of each strategy were likewise estimated and compared for one patient. ResultsThe Evolutive library ART strategy involved a number of added CBCTs: 0 for 55%; 1 for 30%; 2 for 5%; and 3 for 10% of patients. Compared with the other four, this strategy provided the highest CTV geometric coverage by the PTV, with a mean (min-max) coverage of 98.5% (96.4-100) for 10 mm margins and 96.2% (93.0-99.7) for 7 mm margins (P < 0.05). Moreover, this strategy significantly decreased the geometric coverage of the bowel. CTV undercoverage by PTV occurred in the anterior and superior uterine regions for all strategies. The dosimetric analysis at 7 mm similarly demonstrated that the Evolutive library ART increased the V-42.75Gy of the CTV by 27%, 20%, 13%, and 28% compared with Standard RT, ITV-based RT, MidTtReplan, and Pretreatment library ART, respectively. The dose to the bowel was also decreased by the Evolutive library ART compared with that by the other strategies. ConclusionThe Evolutive library ART is a personalized ART strategy that comprises a pretreatment planning library of three CT scans, enriched for half of the patients by one to three per-treatment CBCTs. This original strategy increased both the CTV coverage and bowel sparing compared with all the other tested strategies and enables us to consider a PTV margin reduction.

External radiotherapy is extensively used to treat cervix carcinoma. It is based on the acquisition of a planning CT scan on which the treatment is optimized before being delivered over 25 fractions. However, large pertreatment anatomical variations, hamper the dose delivery accuracy, with a risk of tumor under-dose and healthy organs over-dose resulting to recurrence and toxicity. We propose to generate a patient-specific treatment library based on a population analysis. First, the cervix meshes of the population were registered towards a template anatomy using a deformable mesh registration (DMR). The DMR follows an iterative point matching approach based on the local shape context (histogram of cylindrical neighbor coordinates and normalized geodesic distance to the cervix base), a topology constraint filter, a thin-plate-spline interpolation and a Gaussian regularization. Second, a standard principal component analysis (PCA) model was generated to estimate the dominant deformation modes of the population. Posterior PCA was computed to generate different potential anatomies of the target. For a new patient, her cervix was registered towards the template and her pre-treatment library was modeled. This method was applied on the data of 19 patients (282 images), using a leave-one-patient-out. The DMR was evaluated using point-to-point distance (mean: 1.3 mm), Hausdorff distance (5.7 mm), dice coefficient (0.96) and mean triangle area difference (0.49 mm(2)). The performances of two modeled libraries (2 and 6 modeled anatomies) were compared to a classic pre-treatment library based on 3 planning CTs, showing better results according to both target and healthy organs coverage.

L’IRM peut visualiser une invasion des vésicules séminales en cas de cancer prostatique. Pour ces cancers de stade T3b, délivrer une dose totale élevée (d’au moins 70 Gy) à visée curative dans les invasions des vésicules séminales peut être envisagé en respectant les contraintes de dose dans les organes à risque. L’objectif de cette étude rétrospective était d’analyser la dose délivrée dans les invasions des vésicules séminales et les résultats cliniques. Cette analyse monocentrique a inclus la totalité des 96 patients irradiés dans le centre Eugène-Marquis entre 2009 et 2016 pour un cancer prostatique de stade T3b. L’IRM a été relue. Une analyse dosimétrique avec recueil des contours du volume cible anatomoclinique de haute dose a été effectuée. Les récidives biochimique/clinique et la toxicité ont été analysées (Common Terminology Criteria for Adverse Events [CTCAE] v4.0). Les stades, au toucher rectal, étaient T1 (13 %), T2 (44 %) ouT3 (43 %). Les scores de Gleason étaient 6 (5 %), 7 (50 %) ou 8–10 (45 %). La concentration moyenne d’antigène spécifique de la prostate était de 24 ng/mL. L’invasion des vésicules séminales intéressait au moins le tiers proximal (100 %), les deux tiers (35 %), la totalité (18 %) et les deux vésicules séminales (41 %). L’atteinte ganglionnaire concernait 22 % des patients. La dose totale médiane délivrée dans la prostate par radiothérapie conformationnelle avec modulation d’intensité (RCMI) était de 78 Gy (extrêmes : 74–80 Gy). Le volume cible anatomoclinique de haute dose incluait les vésicules séminales envahies sur l’IRM dans leur tiers proximal, deux tiers et totalité pour respectivement 66 %, 59 % et 0 %. En cas d’invasion des vésicules séminales dans leur totalité, les deux tiers des vésicules séminales étaient inclus dans le volume cible anatomoclinique de haute dose dans 50 % des cas. Le suivi médian était de 26 mois (extrêmes : 6–84 mois). Les taux de récidives biochimique et clinique à 3 ans étaient respectivement de 14 % (intervalle de confiance à 95 % [IC95 %] : 5–23 %) et 7 % (IC95 % : 0–14 %). La toxicité aiguë digestive était de 0 % et celle urinaire de grade 3 de 2,3 %. Les taux de toxicité à 3 ans digestive et urinaire de grade 2 ou plus étaient de 5 % (IC95 % : 0–10 %) et 18 % (IC95 % : 9–27 %). Cinq patients ont souffert d’une toxicité tardive de grade 3. L’irradiation de haute dose des cancers prostatiques de stade T3b conduit à une toxicité modérée. Une étude multicentrique avec recueil dosimétrique est en cours pour préciser la dose reçue par les vésicules séminales et les organes à risque.

fields.Treatment was delivered with a Novalis-TrueBeam™ STx Linac (Palo Alto, CA, USA).IGRT was achieved with ExacTrac® (version 6.0).ExacTrac® documented the eye position before and after each irradiation field. ResultsNo local failure and no case of enucleation have been seen at a median follow-up time of 329 days (range 98 -678).Complications observed so far were impairment of visual acuity in half of the cases, intraocular haemorrhage (1 pts.), xerophthalmia (2 pts.), or keratritis (2 pts).The minimal, mean, and maximal doses within the target volumes were 86.3 (± 5.2)%, corresponding to V95% = 98.3 (± 1.4)%, 100.0 (± 0.4)%, and 103.4 (± 1.1)%, respectively.The conformity index was 1.23 ± 0.16 and the homogeneity index was 0.04 ± 0.01.Mean dose applied to the ipsilateral eye lens, cornea, normal tissue of the involved eye, and the lacrimal gland were 12.1 (± 17.7) Gy, 6.8 (± 11.5) Gy, 18.1 (± 9.2) Gy, and 10.7 (± 7.6) Gy, respectively.Maximal dose of the ipsilateral optic nerve was 31.7 (± 15.9) Gy.Doses delivered to the contralateral eye, lens, optic nerve, and lacrimal gland were less than 0.6 (± 0.7) Gy, 0.2 (± 0.1) Gy, 1.3 (± 1.6) Gy, and 0.2 (± 0.1) Gy, respectively.The doses given to the chiasma did not exceed 1.3 (± 1.5) Gy; the pituitary gland 0.9 (± 1.4) Gy, and the maximal dose to the brain did not exceed 11.1 (± 4.9) Gy.The ITV did not exceed 2mm. ConclusionHybridArc® in combination with peritumoral tissue markers for image-guidance provides highly conformal and homogenous doses distributions for the treatment of small and moving target volumes.

Objectif de l’etude L’objectif etait de comparer plusieurs strategies de radiotherapie, dont la radiotherapie adaptative pour des cancers du col localement evolues, avec un critere de jugement geometrique de recouvrement du volume cible anatomoclinique (CTV) et des organes a risque par le volume cible previsionnel (PTV). Materiel et methode Seize patientes atteintes d’un cancer cervical de stade IB2-IIIB ont eu trois scanographies de planification, correspondant a trois volumes de vessie (vide, intermediaire et pleine) et des tomographies coniques bihebdomadaires pendant les cinq semaines d’irradiation. Les structures analysees sur chaque modalite d’imagerie etaient : le CTV tumoral (incluant la tumeur, l’uterus, la partie superieure du vagin et les parametres), la vessie, le rectum et la cavite peritoneale. Trois techniques d’irradiation ont ete comparees : la strategie « standard » (scanographie avec vessie intermediaire ; PTV avec marge de 10 mm) ; la radiotherapie adaptative par « bibliotheque de plans de traitement » (trois scanographies ; PTV avec marge de 10 mm), le choix du plan optimal etant celui dont le score de similarite Dice (CTV du jour/CTVs de la librairie) etait le plus eleve ; la radiotherapie avec creation d’un volume cible interne (ITV) (somme des CTVs des trois scanographies et marge PTV de 7 mm). Le critere de jugement etait le volume de recouvrement par le PTV de planification du CTV et des organes a risque lors des differentes seances. Resultats Le pourcentage de recouvrement moyen du CTV par le PTV etait significativement plus important en cas de radiotherapie adaptative qu’avec la radiotherapie avec un ITV et qu’avec la radiotherapie standard : respectivement 96 % (73–100) contre 95 % (73–100) et 94 % (71–100). Le recouvrement de la cavite peritoneale par le PTV etait significativement plus faible en cas de radiotherapie adaptative qu’avec la radiotherapie avec un ITV et qu’avec la radiotherapie standard : respectivement 25,3 cm 3 (10,6–58,4) contre 28,3 cm 3 (10,1–69,9) contre 27,9 cm 3 (10,7–64,1), sans difference significative pour la vessie et le rectum. Conclusion La radiotherapie adaptative permet d’ameliorer la couverture du CTV et diminuer l’irradiation de la cavite peritoneale. Ces observations devront etre confirmees par une etude dosimetrique.

Purpose: To describe the evolution and to assess the predictive value of metabolic parameters with different SUV threshold segmentations calculated from two 18F-FDG-PET/CT, one prior to and the other one during concomitant chemoradiation therapy (CCRT), for locally-advanced cervical cancer (LACC).Material and methods: 53 patients treated for LACC by CCRT underwent FDG-PET/CT before treatment (PET1) and another one at 40 Gy (PET2). The PET analyzed parameters were: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). MTV5 were automatically segmented using various percentage SUVmax thresholds (30-70%) and fixed SUV thresholds (all voxels with SUV >1-20). The parameters' predictive capabilities for disease-free (DFS) and overall survival (OS) were assessed using the Harrell's C-index (c) and Cox regression model.Results: Depending on the SUVmax threshold, the relative decreases in MTV and TLG from PET1 to PET2 were, on average, 65% (range: 63-70%) and 85% (range: 83-86%), respectively. The strongest predictive threshold segmentations were 55% SUVmax in PET1 and 32% in PET2. Significant predictors of DFS in multivariate analysis (c = 0.82) were MTV1 (55% SUVmax) in PET1 and TLG2 (32% SUVmax) in PET2. MTV1 (55%) was the most significant OS predictor.Conclusions: MTV and TLG calculated with a threshold of 55% SUVmax and 32% SUVmax from pre- and per-treatment PET scans respectively, can be used to predict patient outcome after CCRT for LACC. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Introduction: For locally advanced cervix carcinoma (LACC), bladder filling variations between treatment fractions impact on the cervix position and may result in inadequate target coverage. Consequently, an online adaptive radiotherapy (ART) based on a pre-treatment planning library can be used to treat LACC. The goal of the study was to quantify the dosimetric benefit of an ART strategy with reduced PTV margins.

Purpose. - In case of intensity-modulated radiotherapy (IMRT) for locally advanced cervix carcinoma, the objectives were to quantify the difference between the planned and the delivered doses by a standard irradiation, and to estimate the dosimetric benefit of a pretreatment planning library-based adaptive radiotherapy.Material and methods. - Ten patients with locally advanced cervix carcinoma had three planning CTs corresponding to three bladder volumes: empty, intermediate (vi) and full. On each CT, two IMRT plans were generated to deliver 45 Gy to the planning target volume (PTV), with two different margins: clinical target volume (CTV) + 10 mm and CTV + 15 mm. Using bi-weekly CBCTs, three scenarios of treatment have been simulated and compared: standard IMRT (one vi planning) with 10 and 15 mm margins and adaptive radiotherapy with 10 mm margin. The cumulated dose in the organs at risk was estimated by elastic registration.Result. - In case of standard IMRT, the cumulated dose was significantly different than the planning dose, with an under-dose of the CTV and the bladder, and an over-dose of the rectum and the peritoneal cavity. For 54% of the fractions, the adaptive radiotherapy planning was not based on vi. Considering the cumulated dose and compared to IMRT with 10-mm margin, adaptive radiotherapy increased the dose to the CTV (1.4 Gy for D98%) and decreased slightly the dose to the rectum and the peritoneal cavity. Compared to a standard IMRT with 15 mm margin, adaptive radiotherapy decreased significantly the dose to the rectum (20% for V40), the bladder (13% for V40) and the peritoneal cavity (2% for V35).Conclusion. - A pretreatment planning library-based adaptive radiotherapy in cervix carcinoma decreases the dose to the organs at risk and increases the dose to the CTV. (C) 2015 Published by Elsevier Masson SAS on behalf of the Societe francaise de radiotherapie oncologique (SFRO).

Due to anatomical variations (mainly bladder filling), an online adaptive radiation therapy (ART) based on a pretreatment planning library can be used to treat locally advanced cervix carcinoma (LACC). The goal of the study was to quantify the dosimetric benefit of an ART strategy with reduced planning target volume (PTV) margins. Eight LACC patients (IB2-IIIB) had 3 planning CT scans: with full, intermediate, and empty bladder. The clinical target volume (CTV) T comprised the cervix tumor, the uterus, the vagina, and the parametriuma depending on the stage of the disease, CTV N comprised the pelvic lymph nodes. On each CT, 2 intensity modulated RT plans were generated in order to deliver 45 Gy to the PTV with different margins: either with standard PTV margins (CTV+1.5 cm in ant-post and laterally and + 2cm in superior directions) or with reduced PTV margins (CTV+0.6 cm in each direction). For the pelvic lymph nodes, the PTV margins were 7 mm. Twelve cone beam computed tomography (CBCT) scans for each patient were acquired during the 5 weeks of treatment. The anatomical structures were manually delineated in each of them. A total of 4 scenarios of treatment were then simulated for each patient, based on the use of the different planning, after a pelvic bone registration. Two scenarios corresponded to the intermediate bladder plans (i.e., the standard treatment without ART), with standard and reduced margins. The 2 others corresponded to ART, with standard and reduced margins. The choice of the most appropriate ART planning for each CBCT was based on dosimetric criteria: privileging first the CTV coverage and then, the organ at risk (OAR) sparing. For each scenario, the cumulated doses in the OAR were finally estimated by deforming the dose according to the anatomical variations estimated by deformable image registration (demon algorithm). Wilcoxon test was used to compare values from the different scenarios. The table displays the estimated percentage of the OARs receiving 45 Gy (V45), depending on the treatment scenarios after dose accumulation, for the 8 patients. The sigmoid V45 and the CTV V99 were calculated, from the CBCT, without deformable registration.Poster Viewing Abstracts 2677; Table 1Anatomical structures and V45 or V99 (%) (median) Scenarios and marginsRectum V45Bladder V45Small bowel V45Sigmoid V45CTV T V99PlanningStandard margins58,227,39,138,3100Reduced margins29,811,97,918,2100Non ART(cumulated)Standard margins63,122,69,7838,699,6Reduced margins19,710,66,622,594,6ART(cumulated)Standard margins60,420,910,833,099,7Reduced margins22,49,35,619,298,6The doses in the OARs are significantly lower in case of ART with reduced margins compared with non-ART with standard margins. Open table in a new tab The doses in the OARs are significantly lower in case of ART with reduced margins compared with non-ART with standard margins. Compared to a standard non-ART, ART with reduced margins in LACC reduces dramatically the dose in the OARs, while treating properly the CTV, and may therefore decrease the risk of genitourinary and gastrointestinal toxicities.

Purpose/objective: Whole "conventional" pelvic irradiation (up to 45-50 Gy) following hysterectomy is associated with a high rate of adverse gastro-intestinal (GI) adverse events, of which around 60% correspond to acute grade 2 toxicity. The phase II RTCMIENDOMETRE trial was designed to test the hypothesis that IMRT could reduce the incidence of grade 2 or more acute GI toxicity to less than 30% in patients irradiated post-operatively for an endometrial cancer.Materials/methods: Patients with post-operative stage Ib G3, Ic or II endometrial carcinomas with no history of chronic inflammatory bowel disease were eligible. Guidelines for volume delineation and dose prescription were detailed in the-protocol. The investigators were advised to use a web-based atlas developed for the RTOG 0418 study. The dose of the vaginal and nodal PTV was 45 Gy in 25 fractions. To assess the ability of the participating centres to comply with the protocol guidelines, they were requested to complete a dummy run procedure before inclusion of their 1st patient. GI and genito-urinary (GU) toxicity were graded according to the CTCAE V 3.0 classification and were prospectively recorded every week during irradiation, as well as at time of brachytherapy insertions and during the follow-up visit at week 15 (W15). Special attention was given to note any changes to the grade of adverse events between W5 and W15.Results: From May 2008 to April 2010, 49 patients from 6 centres were recruited for the trial. One patient could not be treated, one patient died of vascular stroke at W3 without toxicity, and 1 patient refused to be followed-up after treatment. Thus, 46 cases were available for analysis at W15. The distribution by stage was as follows: Ib 16.3%, Ic 64.2%, II 20.4%. Thirty six patients (75%) received an additional vaginal vault boost of 6-10 Gy delivered by HDR brachytherapy in 1 or 2 fractions. Among the 47 patients who completed IMRT, 27% (95% CI 14.5-39.7%) developed at least 1 GI grade 2 adverse event (diarrhoea in 92% of cases), which mainly occurred at W4 and W5. No event corresponding to grade 3 or above was recorded. At W15, the number of patients complaining about GI events was low: 5 patients complained about persistent grade 1 diarrhoea, and 4 patients complained about haemorrhoids. Nineteen percent (95% CI 8.9-32.6%) of patients experienced grade 2 cystitis or urinary frequency which had disappeared by W15.Conclusion: In accordance with our hypothesis, post-operative IMRT resulted in a low rate (less than 30%) of acute GI grade 2 toxicity, in patients with endometrial carcinomas. At W15, no patient demonstrated a grade 2 adverse event, and the prevalence of remaining grade 1 events was less than 20%. (C) 2014 The Authors. Published by Elsevier Ireland Ltd.

These prospective study included 53 patients treated for locally advanced cervical cancer by external beam radiation therapy with concurrent chemotherapy, followed by brachytherapy and + surgery. All patients were evaluated by FDG PET/CT before treatment (PET1) and at 40 Gy (PET2). PET-parameters analysed were: maximum standardized uptake value (SUVmax1, SUVmax2), metabolic tumour volume (MTV1, MTV2), and total lesion glycolysis (TLG1, TLG2). MTV1 and MTV2 were automatically segmented (region-growing) using different thresholds (between 30% and 80% of SUVmax). The recurrence were defined based on clinical examination, MRI and PET imaging. Median follow-up was 30 months [range: 8-60]. A total of 13 patients developed disease recurrence and 7 died of disease. The predictive capabilities of the PET parameters to predict overall recurrence were tested using Cox proportional hazards regression models (p values calculated). Comparisons among different models were done by calculating the Harrel’s C-index (c).