Early Treatment Response Assessment Using F-18-FET PET Compared with Contrast-Enhanced MRI in Glioma Patients After Adjuvant Temozolomide Chemotherapy

SOC NUCLEAR MEDICINE INC 2021

Background: The goal of this study was to compare the value of contrast-enhanced MRI and O-(2-[F-18]fluoroethyl)-L-tyrosine (F-18-FET) PET for response assessment in gliomapatients after adjuvant temozolomide chemotherapy (TMZ). Methods: After biopsy or resection and completion of radiotherapywith concomitant TMZ, 41 newly diagnosed andhistomolecularlycharacterizedgliomapatients (glioblastoma, 90%; age range, 20-79 y) were subsequently treated with adjuvant TMZ. MR and F-18-FETPET imagingwereperformedatbaseline andafter the second cycle of adjuvant TMZ. We obtained F-18-FETmetabolic tumor volumes (MTVs) as well as mean and maximum tumor-to-brain ratios (TBRmean and TBRmax, respectively). Threshold values of F-18-FET PET parameters to predict outcome were established by receiver-operating-characteristic analyses using a median progression-free survival (PFS) of >= 9 mo and overall survival (OS) of >= 15 mo as reference. MRI response assessment was based on the Response Assessment in Neuro-Oncology (RANO) working group criteria. The predictive value of changes of F-18-FET PET andMRI parameters on survival was evaluated subsequently using univariate andmultivariate survival estimates. Results: After 2 cycles of adjuvant TMZ chemotherapy, a treatmentinduced reduction of MTV and TBRmax predicted a significantly longer PFS and OS (both P <= 0.03; univariate survival analyses) whereas RANO criteria were not significant (P = 0.05). Multivariate survival analysis revealed that TBRmax changes predicted a prolonged PFS (P > 0.012) and changes of MTV a prolonged OS (P > 0.005) independent of O-6-methylguanine-DNA-methyltransferase promoter methylation and other strong prognostic factors. Conclusion: Changes of F-18-FET PET parameters appear to be helpful for identifying responders to adjuvant TMZ early after treatment initiation.

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K7U oai:USBKOELN.ub.uni-koeln.de:59634
Ceccon, Garry, Lohmann, Philipp ORCID: 0000-0002-5360-046X , Werner, Jan-Michael ORCID: 0000-0001-7147-4594 , Tscherpel, Caroline, Dunkl, Veronika, Stoffels, Gabriele, Rosen, Jurij, Rapp, Marion, Sabel, Michael, Herrlinger, Ulrich, Schaefer, Niklas, Shah, Nadim J., Fink, Gereon R. ORCID: 0000-0002-8230-1856 , Langen, Karl-Josef ORCID: 0000-0003-1101-5075 and Galldiks, Norbert (2021). Early Treatment Response Assessment Using F-18-FET PET Compared with Contrast-Enhanced MRI in Glioma Patients After Adjuvant Temozolomide Chemotherapy. J. Nucl. Med., 62 (7). S. 918 - 926. RESTON: SOC NUCLEAR MEDICINE INC. ISSN 1535-5667
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