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OtherClinical Investigations (Human)

Early treatment response assessment using 18F-FET PET compared to contrast-enhanced MRI in glioma patients following adjuvant temozolomide chemotherapy

Garry Ceccon, Philipp Lohmann, Jan-Michael Werner, Caroline Tscherpel, Veronika Dunkl, Gabriele Stoffels, Jurij Rosen, Marion Rapp, Michael Sabel, Ulrich Herrlinger, Niklas Schaefer, Nadim J Shah, Gereon R Fink, Karl-Josef Langen and Norbert Galldiks
Journal of Nuclear Medicine November 2020, jnumed.120.254243; DOI: https://doi.org/10.2967/jnumed.120.254243
Garry Ceccon
1 University Hospital Cologne, Germany;
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Philipp Lohmann
2 Research Center Juelich, Germany;
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Jan-Michael Werner
1 University Hospital Cologne, Germany;
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Caroline Tscherpel
1 University Hospital Cologne, Germany;
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Veronika Dunkl
1 University Hospital Cologne, Germany;
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Gabriele Stoffels
2 Research Center Juelich, Germany;
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Jurij Rosen
1 University Hospital Cologne, Germany;
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Marion Rapp
3 University Hospital Duesseldorf, Germany;
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Michael Sabel
3 University Hospital Duesseldorf, Germany;
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Ulrich Herrlinger
4 University Hospital Bonn, Germany;
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Niklas Schaefer
4 University Hospital Bonn, Germany;
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Nadim J Shah
5 Reseach Center Juelich, Germany
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Gereon R Fink
1 University Hospital Cologne, Germany;
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Karl-Josef Langen
5 Reseach Center Juelich, Germany
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Norbert Galldiks
1 University Hospital Cologne, Germany;
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Abstract

Background: The goal of this study was to compare the value of contrast-enhanced MRI and O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) PET for response assessment in glioma patients following adjuvant temozolomide chemotherapy (TMZ). Methods: After biopsy or resection and completion of radiotherapy with concomitant TMZ, 41 newly diagnosed and histomolecularly characterized glioma patients (glioblastoma, 90%; age range, 20-79 years) were subsequently treated with adjuvant TMZ. MR and 18F-FET PET imaging were performed at baseline and after the second cycle of adjuvant TMZ. We obtained 18F-FET metabolic tumor volumes (MTV) as well as mean and maximum tumor-to-brain ratios (TBRmean, TBRmax). Threshold values of 18F-FET PET parameters to predict outcome were established by ROC analyses using a median progression-free survival (PFS) of ≥9 months and overall survival (OS) of ≥15 months as reference. MRI response assessment was based on RANO criteria. The predictive value of changes of 18F-FET PET and MRI parameters on survival was evaluated subsequently using univariate and multivariate survival estimates. Results: After two cycles of adjuvant TMZ chemotherapy, a treatment-induced reduction of MTV and TBRmax predicted a significantly longer PFS and OS (both P ≤ 0.03; univariate survival analyses) while 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 O6-methylguanine-DNA-methyltransferase promoter methylation and other strong prognostic factors. Conclusion: Changes of 18F-FET PET parameters appear to be helpful for identifying responders to adjuvant TMZ early after treatment initiation.

  • Neurology
  • Oncology: Brain
  • PET
  • Amino acid PET
  • metabolic tumor volume
  • pseudoprogression
  • treatment monitoring
  • treatment-related changes
  • Copyright © 2020 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (2)
Journal of Nuclear Medicine
Vol. 62, Issue 2
February 1, 2021
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Early treatment response assessment using 18F-FET PET compared to contrast-enhanced MRI in glioma patients following adjuvant temozolomide chemotherapy
Garry Ceccon, Philipp Lohmann, Jan-Michael Werner, Caroline Tscherpel, Veronika Dunkl, Gabriele Stoffels, Jurij Rosen, Marion Rapp, Michael Sabel, Ulrich Herrlinger, Niklas Schaefer, Nadim J Shah, Gereon R Fink, Karl-Josef Langen, Norbert Galldiks
Journal of Nuclear Medicine Nov 2020, jnumed.120.254243; DOI: 10.2967/jnumed.120.254243

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Early treatment response assessment using 18F-FET PET compared to contrast-enhanced MRI in glioma patients following adjuvant temozolomide chemotherapy
Garry Ceccon, Philipp Lohmann, Jan-Michael Werner, Caroline Tscherpel, Veronika Dunkl, Gabriele Stoffels, Jurij Rosen, Marion Rapp, Michael Sabel, Ulrich Herrlinger, Niklas Schaefer, Nadim J Shah, Gereon R Fink, Karl-Josef Langen, Norbert Galldiks
Journal of Nuclear Medicine Nov 2020, jnumed.120.254243; DOI: 10.2967/jnumed.120.254243
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Keywords

  • Neurology
  • Oncology: Brain
  • PET
  • amino acid PET
  • metabolic tumor volume
  • pseudoprogression
  • treatment monitoring
  • treatment-related changes
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