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18F-FET PET prior to recurrent high-grade glioma re-irradiation—additional prognostic value of dynamic time-to-peak analysis and early static summation images?

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Abstract

Most high-grade gliomas (HGG) recur after initial multimodal therapy and re-irradiation (Re-RT) has been shown to be a valuable re-treatment option in selected patients. We evaluated the prognostic value of dynamic time-to-peak analysis and early static summation images in O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) PET for patients treated with Re-RT ± concomitant bevacizumab. We retrospectively analyzed 72 patients suffering from recurrent HGG with 18F-FET PET prior to Re-RT. PET analysis revealed the maximal tumor-to-background-ratio (TBRmax), the biological tumor volume, the number of PET-foci and pattern of time-activity-curves (TACs; increasing vs. decreasing). Furthermore, the novel PET parameters early TBRmax (at 5–15 min post-injection) and minimal time-to-peak (TTPmin) were evaluated. Additional analysis was performed for gender, age, KPS, O6-methylguanine-DNA methyltransferase methylation status, isocitrate dehydrogenase 1 mutational status, WHO grade and concomitant bevacizumab therapy. The influence of PET and clinical parameters on post-recurrence survival (PRS) was investigated. Shorter TTPmin was related to shorter PRS after Re-RT with 6 months for TTPmin < 12.5 min, 7 months for TTPmin 12.5–25 min and 11 months for TTPmin >25 min (p = 0.027). TTPmin had a significant impact on PRS both on univariate (p = 0.027; continuous) and multivariate analysis (p = 0.011; continuous). Other factors significantly related to PRS on multivariate analysis were increasing vs. decreasing TACs (p = 0.008) and Karnofsky Performance Score (p = 0.015; <70 vs. ≥70). Early TBRmax as well as the other conventional PET parameters were not significantly related to PRS on univariate analysis. Dynamic 18F-FET PET with TTPmin provides a high prognostic value for recurrent HGG prior to Re-RT, whereas early TBRmax does not. Dynamic 18F-FET PET using TTPmin might help to personalize Re-RT treatment regimens in future through voxelwise TTPmin analysis for dose painting purposes and PET-guided dose escalation.

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Acknowledgements

We thank Alexander Nieto for proofreading the manuscript.

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    Authors and Affiliations

    1. Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

      Daniel F. Fleischmann, Claus Belka & Maximilian Niyazi

    2. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

      Daniel F. Fleischmann, Claus Belka & Maximilian Niyazi

    3. Department of Nuclear Medicine, LMU Munich, Munich, Germany

      Marcus Unterrainer, Peter Bartenstein & Nathalie L. Albert

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    1. Daniel F. Fleischmann
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    Daniel F. Fleischmann and Marcus Unterrainer have contributed equally to this work.

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    Fleischmann, D.F., Unterrainer, M., Bartenstein, P. et al. 18F-FET PET prior to recurrent high-grade glioma re-irradiation—additional prognostic value of dynamic time-to-peak analysis and early static summation images?. J Neurooncol 132, 277–286 (2017). https://doi.org/10.1007/s11060-016-2366-8

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