3′-Deoxy-3′-18F-Fluorothymidine PET and MRI for Early Survival Predictions in Patients with Recurrent Malignant Glioma Treated with Bevacizumab

被引：100

作者：

Schwarzenberg, Johannes ^{[1
,2
,3
]}

Czernin, Johannes ^{[1
,2
]}

Cloughesy, Timothy F. ^{[4
]}

Ellingson, Benjamin M. ^{[5
]}

Pope, Whitney B. ^{[5
]}

Geist, Cheri ^{[1
,2
]}

Dahlbom, Magnus ^{[1
,2
]}

Silverman, Daniel H. S. ^{[1
,2
]}

Satyamurthy, Nagichettiar ^{[1
]}

Phelps, Michael E. ^{[1
]}

Chen, Wei ^{[1
,2
]}

机构：

[1] Univ Calif Los Angeles, Dept Mol & Med Pharmacol, Los Angeles, CA 90005 USA

[2] Univ Calif Los Angeles, Ahmanson Translat Imaging Div, Los Angeles, CA 90005 USA

[3] Med Univ Vienna, Dept Pediat & Adolescent Med, Vienna, Austria

[4] Univ Calif Los Angeles, Dept Neurol, Los Angeles, CA 90005 USA

[5] Univ Calif Los Angeles, Dept Radiol Sci, Los Angeles, CA 90005 USA

来源：

JOURNAL OF NUCLEAR MEDICINE | 2012年 / 53卷 / 01期

基金：

美国国家卫生研究院;

关键词：

F-18-FLT PET; bevacizumab; malignant glioma; survival prediction; POSITRON-EMISSION-TOMOGRAPHY; HIGH-GRADE GLIOMA; ENDOTHELIAL GROWTH-FACTOR; BRAIN-TUMORS; PHASE-II; GLIOBLASTOMA-MULTIFORME; IMAGING PROLIFERATION; RADIATION NECROSIS; ANTIANGIOGENIC THERAPY; GENE-THERAPY;

D O I：

10.2967/jnumed.111.092387

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：

With the dismal prognosis for malignant glioma patients, survival predictions become key elements in patient management. This study compares the value of 3'-deoxy-3'-F-18-fluorothymidine (F-18-FLT) PET and MRI for early outcome predictions in patients with recurrent malignant glioma on bevacizumab therapy. Methods: Thirty patients treated with bevacizumab combination therapy underwent F-18-FLT PET immediately before and at 2 and 6 wk after the start of treatment. A metabolic treatment response was defined as a decrease of equal to or greater than 25% in tumor F-18-FLT uptake (standardized uptake values) from baseline using receiver-operating-characteristic analysis. MRI treatment response was assessed at 6 wk according to the Response Assessment in Neurooncology criteria. F-18-FLT responses at different times were compared with MRI response and correlated with progression-free survival and overall survival using Kaplan-Meier analysis. Metabolic response based on F-18-FLT was further compared with other outcome predictors using Cox regression analysis. Results: Early and late changes in tumor F-18-FLT uptake were more predictive of overall survival than MRI criteria (P < 0.001 and P = 0.01, respectively). F-18-FLT uptake changes were also predictive of progression-free survival (P, 0.001). The median overall survival for responders was 3.3 times longer than for nonresponders based on F-18-FLT PET criteria (12.5 vs. 3.8 mo, P < 0.001) but only 1.4 times longer using MRI assessment (12.9 vs. 9.0 mo, P = 0.05). On the basis of the 6-wk F-18-FLT PET response, there were 16 responders (53%) and 14 nonresponders (47%), whereas MRI identified 9 responders (7 partial response, 2 complete response, 31%) and 20 nonresponders (13 stable disease, 7 progressive disease, 69%). In 7 of the 8 discrepant cases between MRI and PET, F-18-FLT PET was able to demonstrate response earlier than MRI. Among various outcome predictors, multivariate analysis identified F-18-FLT PET changes at 6 wk as the strongest independent survival predictor (P < 0.001; hazard ratio, 10.051). Conclusion: Changes in tumor F-18-FLT uptake were highly predictive of progression-free and overall survival in patients with recurrent malignant glioma on bevacizumab therapy. F-18-FLT PET seems to be more predictive than MRI for early treatment response.

引用

页码：29 / 36

页数：8

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