Early treatment response evaluation using FET PET compared to MRI in glioblastoma patients at first progression treated with bevacizumab plus lomustine

被引:43
作者
Galldiks, Norbert [1 ,2 ,3 ]
Dunkl, Veronika [1 ]
Ceccon, Garry [1 ]
Tscherpel, Caroline [1 ,2 ]
Stoffels, Gabriele [2 ]
Law, Ian [4 ]
Henriksen, Otto M. [4 ]
Muhic, Aida [5 ]
Poulsen, Hans S. [5 ]
Steger, Jan [1 ]
Bauer, Elena K. [1 ]
Lohmann, Philipp [2 ]
Schmidt, Matthias [6 ]
Shah, Nadim J. [2 ,7 ]
Fink, Gereon R. [1 ,2 ]
Langen, Karl-Josef [2 ,8 ]
机构
[1] Univ Hosp Cologne, Dept Neurol, Josef Stelzmann St 9, D-50937 Cologne, Germany
[2] Forschungszentrum Juelich, Inst Neurosci & Med INM 3 4, Leo Brandt St 5, D-52425 Julich, Germany
[3] Univ Cologne & Bonn, CIO, Cologne, Germany
[4] Rigshosp, Copenhagen Univ Hosp, Dept Clin Physiol Nucl Med & PET, Copenhagen, Denmark
[5] Rigshosp, Copenhagen Univ Hosp, Dept Oncol, Copenhagen, Denmark
[6] Univ Hosp Cologne, Dept Nucl Med, Cologne, Germany
[7] Univ Hosp Aachen, Dept Neurol, Aachen, Germany
[8] Univ Hosp Aachen, Dept Nucl Med, Aachen, Germany
关键词
CCNU; Amino acid PET; Glioma; Treatment-related changes; Tumour relapse; POSITRON-EMISSION-TOMOGRAPHY; RECURRENT MALIGNANT GLIOMA; AMINO-ACID PET; ANTIANGIOGENIC THERAPY; BRAIN; CRITERIA;
D O I
10.1007/s00259-018-4082-4
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
BackgroundThe goal of this prospective study was to compare the value of both conventional MRI and O-(2-F-18-fluoroethyl)-L-tyrosine (FET) PET for response evaluation in glioblastoma patients treated with bevacizumab plus lomustine (BEV/LOM) at first progression.MethodsAfter chemoradiation with concomitant and adjuvant temozolomide, 21 IDH wild-type glioblastoma patients at first progression (age range, 33-75years; MGMT promoter unmethylated, 81%) were treated with BEV/LOM. Contrast-enhanced MRI and FET-PET scans were performed at baseline and after 8-10weeks. We obtained FET metabolic tumor volumes (MTV) and tumor/brain ratios. Threshold values of FET-PET parameters for treatment response were established by ROC analyses using the post-progression overall survival (OS) />9months as the reference. MRI response assessment was based on RANO criteria. The predictive ability of FET-PET thresholds and MRI changes on early response assessment was evaluated subsequently concerning OS using uni- and multivariate survival estimates.ResultsEarly treatment response as assessed by RANO criteria was not predictive for an OS>9months (P=0.203), whereas relative reductions of all FET-PET parameters significantly predicted an OS>9months (P<0.05). The absolute MTV at follow-up enabled the most significant OS prediction (sensitivity, 85%; specificity, 88%; P=0.001). Patients with an absolute MTV below 5ml at follow-up survived significantly longer (12 vs. 6months, P<0.001), whereas early responders defined by RANO criteria lived only insignificantly longer (9 vs. 6months; P=0.072). The absolute MTV at follow-up remained significant in the multivariate survival analysis (P=0.006).ConclusionsFET-PET appears to be useful for identifying responders to BEV/LOM early after treatment initiation.
引用
收藏
页码:2377 / 2386
页数:10
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