The prognostic value of FET PET at radiotherapy planning in newly diagnosed glioblastoma

Abstract

BackgroundGlioblastoma patients show a great variability in progression free survival (PFS) and overall survival (OS). To gain additional pretherapeutic information, we explored the potential of O-(2-18F-fluoroethyl)-L-tyrosine (FET) PET as an independent prognostic biomarker.MethodsWe retrospectively analyzed 146 consecutively treated, newly diagnosed glioblastoma patients. All patients were treated with temozolomide and radiation therapy (RT). CT/MR and FET PET scans were obtained postoperatively for RT planning. We used Cox proportional hazards models with OS and PFS as endpoints, to test the prognostic value of FET PET biological tumor volume (BTV).ResultsMedian follow-up time was 14 months, and median OS and PFS were 16.5 and 6.5 months, respectively. In the multivariate analysis, increasing BTV (HR = 1.17, P < 0.001), poor performance status (HR = 2.35, P < 0.001), O(6)-methylguanine-DNA methyltransferase protein status (HR = 1.61, P = 0.024) and higher age (HR = 1.32, P = 0.013) were independent prognostic factors of poor OS. For poor PFS, only increasing BTV (HR = 1.18; P = 0.002) was prognostic. A prognostic index for OS was created based on the identified prognostic factors.ConclusionLarge BTV on FET PET is an independent prognostic factor of poor OS and PFS in glioblastoma patients. With the introduction of FET PET, we obtain a prognostic index that can help in glioblastoma treatment planning.Electronic supplementary materialThe online version of this article (doi:10.1007/s00259-016-3494-2) contains supplementary material which is available to authorized users.

Simultaneous FET-PET and contrast-enhanced MRI based on hybrid PET/MR improves delineation of tumor spatial biodistribution in gliomas: a biopsy validation study

“…Justin et al proposed that performing maximum tumor resection according to findings on T2 and FLAIR images was associated with better prognosis in low-grade glioma [41]. Sidsel et al found that a large tumor volume on FET-PET was an independent predictor of poor survival in GBM patients [42]. The postoperative tumor volume, when based on FET-PET, has also been shown a significant impact on prognosis in GBM patients [39].…”

Non-FDG PET/CT in Diagnostic Oncology: a pictorial review

“…Clinical indications in oncology (Figs. 8, 9, and 10) Diagnosis of central nervous system tumours (very low background in healthy brain) (Galldiks et al 2015;Albert et al 2016;Unterrainer et al 2016;Kunz et al 2011;Poulsen et al 2017).…”

The use of amino acid PET and conventional MRI for monitoring of brain tumor therapy

“…Moreover, the amount of residual tracer uptake in FET PET after surgery/prior to chemoradiation of glioblastomas (FET PET performed within 7–20 days after surgery) has a strong prognostic influence, even after adjustment by multivariate survival analyses for the effects of treatment, MGMT promoter methylation and other patient and tumor-related factors (Piroth et al, 2011a, Poulsen et al, 2016, Suchorska et al, 2015). These data indicate that resection of malignant gliomas guided by amino acid PET may increase the amount of neoplastic tissue removed, potentially improving patient outcome.…”