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

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 [¹⁸F]-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. [¹⁸F]FET uptake kinetics was classified according to a five-point rating as category G_1–2 (strongly/mainly increasing kinetics), G₃ (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 [¹⁸F]FET–PET is an independent determinant of overall and to a lesser extent also progression-free survival. Thus, [¹⁸F]FET–PET kinetics may provide valuable additional prognostic information for treatment decisions.

Content Type Journal Article
Category Clinical Study
Pages 1-7
DOI 10.1007/s11060-012-0980-7
Authors
- Maximilian Niyazi, Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
- Nathalie Jansen, Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
- Ute Ganswindt, Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
- Silke Birgit Schwarz, Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
- Julia Geisler, Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
- Oliver Schnell, Department of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
- Karen Büsing, Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Sabina Eigenbrod, Department of Neuropathology, Ludwig-Maximilians-University Munich, Feodor-Lynen-Str. 23, 81377 Munich, Germany
- Christian la Fougère, Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
- Claus Belka, Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany