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Background  To evaluate the impact of  18 F-FDG PET/CT on target volume delineation in gynaecological cancer.    Methods  F-FDG PET/CT based RT treatment planning was performed in 10 patients with locally recurrent (n = 5) or post-surgical residual gynaecological cancer (n = 5). The gross tumor volume (GTV) was defined by 4 experienced radiation oncologists first using contrast enhanced CT (GTV CT ) and secondly using the fused  18 F-FDG PET/CT datasets (GTV PET/CT ). In addition, the GTV was delineated using the signal-to-background (SBR) ratio-based adaptive thresholding technique (GTV SBR ). Overlap analysis were conducted to assess geographic mismatches between the GTVs delineated using the different techniques. Inter- and intra-observer variability were also assessed.    Results  The mean GTV CT  (43.65 cm 3 ) was larger than the mean GTV PET/CT  (33.06 cm 3 ), p = 0.02. In 6 patients, GTV PET/CT  added substantial tumor extension outside the GTV CT  even though 90.4% of the GTV PET/CT  was included in the GTV CT  and 30.2% of the GTV CT  was found outside the GTV PET/CT . The inter- and intra-observer variability was not significantly reduced with the inclusion of  18 F-FDG PET imaging (p = 0.23 and p = 0.18, respectively). The GTV SBR  was smaller than GTV CT  p ≤ 0.005 and GTV PET/CT  p ≤ 0.005.    Conclusions  The use of  18 F-FDG PET/CT images for target volume delineation of recurrent or post-surgical residual gynaecological cancer alters the GTV in the majority of patients compared to standard CT-definition. The use of SBR-based auto-delineation showed significantly smaller GTVs. The use of PET/CT based target volume delineation may improve the accuracy of RT treatment planning in gynaecologic cancer.

Impact of 18F-FDG PET/CT on target volume delineation in recurrent or residual gynaecologic carcinoma