Re-irradiation in recurrent malignant glioma: prognostic value of [18F]FET-PET

J Neurooncol. 2012 Dec;110(3):389-95. doi: 10.1007/s11060-012-0980-7. Epub 2012 Oct 4.

Abstract

The aim of the present study is to determine new positron emission tomography (PET) imaging-related factors predictive of progression-free survival as well as survival in patients with recurrent malignant glioma (MG) prior to and after re-irradiation. Fifty-six patients with recurrent MG who underwent re-irradiation treatment and pretherapeutic dynamic [(18)F]-fluoroethyl-L-tyrosine (FET)-PET scan were retrospectively analyzed. The prognostic value of different parameters, such as biological tumor volume, maximal tumor uptake (SUV(max)/BG), mean tumor uptake (SUV(mean)/BG), as well as uptake kinetics, was evaluated. [(18)F]FET uptake kinetics was classified according to a five-point rating as category G(1-2) (strongly/mainly increasing kinetics), G(3) (mixed 1:1), or G(4-5) (mainly/strongly decreasing kinetics). Patients within the pretherapeutic kinetic group G(4-5) had significantly worse survival than the other two groups (p = 0.01). Multivariate analysis revealed that histologic grade, Karnofsky Performance Score (KPS), and kinetic group were independent significant predictors for survival after re-irradiation. The uptake kinetics of [(18)F]FET-PET is an independent determinant of overall and to a lesser extent also progression-free survival. Thus, [(18)F]FET-PET kinetics may provide valuable additional prognostic information for treatment decisions.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brain Neoplasms / diagnostic imaging*
  • Brain Neoplasms / mortality
  • Brain Neoplasms / radiotherapy
  • Female
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Glioma / diagnostic imaging*
  • Glioma / mortality
  • Glioma / radiotherapy
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / radiotherapy
  • Neoplasm Staging
  • Positron-Emission Tomography*
  • Prognosis
  • Radiopharmaceuticals
  • Retrospective Studies
  • Salvage Therapy
  • Survival Rate
  • Tyrosine / analogs & derivatives*
  • Young Adult

Substances

  • O-(2-fluoroethyl)tyrosine
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Tyrosine