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

Journal of Nuclear Medicine

Johannes Schwarzenberg¹  Michael E. Phelps¹  Johannes Czernin¹  Cheri Geist¹  Nagichettiar Satyamurthy¹  Wei Chen¹  Whitney B. Pope¹  Benjamin M. Ellingson¹  Daniel H.S. Silverman¹  Magnus Dahlbom¹  Timothy F. Cloughesy¹ 

关键词: ¹⁸F-FLT PET;    bevacizumab;    malignant glioma;    survival prediction;   

DOI  :  10.2967/jnumed.111.092387

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 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′-18F-fluorothymidine (18F-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 18F-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 18F-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. 18F-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 18F-FLT was further compared with other outcome predictors using Cox regression analysis. Results: Early and late changes in tumor 18F-FLT uptake were more predictive of overall survival than MRI criteria (P < 0.001 and P = 0.01, respectively). 18F-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 18F-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 18F-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, 18F-FLT PET was able to demonstrate response earlier than MRI. Among various outcome predictors, multivariate analysis identified 18F-FLT PET changes at 6 wk as the strongest independent survival predictor (P < 0.001; hazard ratio, 10.051). Conclusion: Changes in tumor 18F-FLT uptake were highly predictive of progression-free and overall survival in patients with recurrent malignant glioma on bevacizumab therapy. 18F-FLT PET seems to be more predictive than MRI for early treatment response.

【 授权许可】

Unknown