Advertisement

Overall survival and progression-free survival in patients with primary brain tumors after treatment: is the outcome of [18F] FDOPA PET a prognostic factor in these patients?

  • Agostino ChiaravallotiEmail author
  • Vincenzo Esposito
  • Francesco Ursini
  • Eugenio Di Giorgio
  • Maddalena Zinzi
  • Ferdinando Calabria
  • Andrea Cimini
  • Orazio Schillaci
Original Article

Abstract

Aim

To investigate the progression-free survival (PFS) and the overall survival (OS) in a population affected by primary brain tumors (PBT) evaluated by [18F]-l-dihydroxyphenylalanine ([18F] FDOPA) positron emission tomography/computed tomography (PET/CT).

Materials and methods

133 subjects with PBT (65 women and 68 men, mean age 45 ± 10 years old) underwent 18F FDOPA PET/CT after treatment. Of them, 68 (51.2%) were Grade II, 34 (25.5%) were Grade III and 31 (23.3%) were Grade IV. PET/CT was scored as positive or negative and standardized uptake value ratio (SUVr) was calculated as the ratio between SUVmax of the lesion vs. that of the background. Patients have been observed for a mean of 24 months.

Results

The outcome of [18F] FDOPA PET/CT scan was significantly related to the OS and PFS in Grade II gliomas. In Grade II PBT, the OS proportions at 24 months were 100% in subjects with a negative PET/CT scan and 82% in those with a positive scan. Gehan–Breslow–Wilcoxon test showed a significant difference in the OS curves (P = 0.03) and the hazard-ratio was equal to 5.1 (95% CI of ratio 1.1–23.88). As for PFS, the proportion at 24 months was 90% in subjects with a negative PET/CT scan and 58% in those with a positive scan. Gehan–Breslow–Wilcoxon test showed a significant difference in the OS curves (P = 0.007) and the hazard-ratio was equal to 4.1 (95% CI of ratio 1.3–8). We did not find any significant relationship between PET outcome and OS and PFS in Grade III and IV PBT.

Conclusions

A positive [18F] FDOPA PET/CT scan is related to a poor OS and PFS in subjects with low-grade PBT. This imaging modality could be considered as a prognostic factor in these subjects.

Keywords

[18F] FDOPA PET/CT Prognostic value Survival Brain tumors Tumor relapse 

Notes

Acknowledgements

The authors wish to thank Tiziana Martino (IRCCS Neuromed, Pozzilli, IT) for data collection.

Funding

The authors have nothing to disclose.

References

  1. 1.
    Weller M, van den Bent M, Tonn JC, Stupp R, Preusser M, Cohen-Jonathan-Moyal E, et al. European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol. 2017;18:e315–e329329.  https://doi.org/10.1016/s1470-2045(17)30194-8.CrossRefGoogle Scholar
  2. 2.
    Ledezma CJ, Chen W, Sai V, Freitas B, Cloughesy T, Czernin J, et al. 18F-FDOPA PET/MRI fusion in patients with primary/recurrent gliomas: initial experience. Eur J Radiol. 2009;71:242–8.CrossRefGoogle Scholar
  3. 3.
    Kondziolka D, Lunsford LD, Martinez AJ. Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma. J Neurosurg. 1993;79:533–66.CrossRefGoogle Scholar
  4. 4.
    Jansen EP, Dewit LG, van Herk M, Bartelink H. Target volumes in radiotherapy for high-grade malignant glioma of the brain. Radiotherapy and oncology. J Eur Soc Ther Radiol Oncol. 2000;56:151–6.CrossRefGoogle Scholar
  5. 5.
    Cicone F, Filss CP, Minniti G, Rossi-Espagnet C, Papa A, Scaringi C, et al. Volumetric assessment of recurrent or progressive gliomas: comparison between F-DOPA PET and perfusion-weighted MRI. Eur J Nucl Med Mol Imaging. 2015;42:905–15.  https://doi.org/10.1007/s00259-015-3018-5.CrossRefGoogle Scholar
  6. 6.
    Fan GG, Deng QL, Wu ZH, Guo Q. Usefulness of diffusion/perfusion-weighted MRI in patients with non-enhancing supratentorial brain gliomas: a valuable tool to predict tumour grading? Br J Radiol. 2006;79:652–8.CrossRefGoogle Scholar
  7. 7.
    Calabria F, Chiaravalloti A, Di Pietro B, Grasso C, Schillaci O. Molecular imaging of brain tumors with 18F-DOPA PET and PET/CT. Nucl Med Commun. 2012;33:563–70.  https://doi.org/10.1097/MNM.0b013e328351d566.CrossRefGoogle Scholar
  8. 8.
    Lapointe S, Perry A, Butowski NA. Primary brain tumours in adults. Lancet (London, England). 2018;392:432–46.  https://doi.org/10.1016/s0140-6736(18)30990-5.CrossRefGoogle Scholar
  9. 9.
    Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131:803–20.  https://doi.org/10.1007/s00401-016-1545-1.CrossRefGoogle Scholar
  10. 10.
    Chen JW, Zhou CF, Lin ZX. The influence of different classification standards of age groups on prognosis in high-grade hemispheric glioma patients. J Neurol Sci. 2015;356:148–52.CrossRefGoogle Scholar
  11. 11.
    Chaichana KL, Jusue-Torres I, Navarro-Ramirez R, Raza SM, Pascual-Gallego M, Ibrahim A, et al. Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma. Neuro-oncology. 2014;16:113–22.CrossRefGoogle Scholar
  12. 12.
    World Medical Association Declaration of Helsinki. ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.  https://doi.org/10.1001/jama.2013.281053.CrossRefGoogle Scholar
  13. 13.
    Villani V, Carapella CM, Chiaravalloti A, Terrenato I, Piludu F, Vidiri A, et al. The role of PET [18F]FDOPA in evaluating low-grade glioma. Anticancer Res. 2015;35:5117–222.Google Scholar
  14. 14.
    Chiaravalloti A, Fiorentini A, Villani V, Carapella C, Pace A, Di Pietro B, et al. Factors affecting (1)(8)F FDOPA standardized uptake value in patients with primary brain tumors after treatment. Nucl Med Biol. 2015;42:355–9.  https://doi.org/10.1016/j.nucmedbio.2015.01.002.CrossRefGoogle Scholar
  15. 15.
    Rose S, Fay M, Thomas P, Bourgeat P, Dowson N, Salvado O, et al. Correlation of MRI-derived apparent diffusion coefficients in newly diagnosed gliomas with [18F]-fluoro-l-dopa PET: what are we really measuring with minimum ADC? AJNR Am J Neuroradiol. 2013;34:758–64.CrossRefGoogle Scholar
  16. 16.
    Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol. 2010;28:1963–72.  https://doi.org/10.1200/jco.2009.26.3541.CrossRefGoogle Scholar
  17. 17.
    Lizarraga KJ, Allen-Auerbach M, Czernin J, DeSalles AA, Yong WH, Phelps ME, et al. (18)F-FDOPA PET for differentiating recurrent or progressive brain metastatic tumors from late or delayed radiation injury after radiation treatment. J Nucl Med. 2014;55:30–6.  https://doi.org/10.2967/jnumed.113.121418.CrossRefGoogle Scholar
  18. 18.
    Karunanithi S, Sharma P, Kumar A, Gupta DK, Khangembam BC, Ballal S, et al. Can (18)F-FDOPA PET/CT predict survival in patients with suspected recurrent glioma? A prospective study. Eur J Radiol. 2014;83:219–25.  https://doi.org/10.1016/j.ejrad.2013.09.004.CrossRefGoogle Scholar
  19. 19.
    Soffietti R, Abacioglu U, Baumert B, Combs SE, Kinhult S, Kros JM, et al. Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO). Neuro-oncology. 2017;19:162–74.  https://doi.org/10.1093/neuonc/now241.CrossRefGoogle Scholar
  20. 20.
    Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol. 2010;195:310–20.  https://doi.org/10.2214/ajr.10.4923.CrossRefGoogle Scholar
  21. 21.
    Schiepers C, Chen W, Cloughesy T, Dahlbom M, Huang SC. 18F-FDOPA kinetics in brain tumors. J Nucl Med. 2007;48:1651–61.  https://doi.org/10.2967/jnumed.106.039321.CrossRefGoogle Scholar
  22. 22.
    Nioche C, Soret M, Gontier E, Lahutte M, Dutertre G, Dulou R, et al. Evaluation of quantitative criteria for glioma grading with static and dynamic 18F-FDopa PET/CT. Clin Nucl Med. 2013;38:81–7.  https://doi.org/10.1097/RLU.0b013e318279fd5a.CrossRefGoogle Scholar
  23. 23.
    Albert NL, Weller M, Suchorska B, Galldiks N, Soffietti R, Kim MM, et al. Response assessment in neuro-oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas. Neuro-oncology. 2016;18:1199–208.  https://doi.org/10.1093/neuonc/now058.CrossRefGoogle Scholar
  24. 24.
    Murphy ES, Leyrer CM, Parsons M, Suh JH, Chao ST, Yu JS, et al. Risk factors for malignant transformation of low-grade glioma. Int J Radiat Oncol Biol Phys. 2018;100:965–71.  https://doi.org/10.1016/j.ijrobp.2017.12.258.CrossRefGoogle Scholar
  25. 25.
    Smith JS, Alderete B, Minn Y, Borell TJ, Perry A, Mohapatra G, et al. Localization of common deletion regions on 1p and 19q in human gliomas and their association with histological subtype. Oncogene. 1999;18:4144–52.  https://doi.org/10.1038/sj.onc.1202759.CrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.Department of Biomedicine and PreventionUniversity “Tor Vergata”RomeItaly
  2. 2.IRCCS NeuromedPozzilliItaly
  3. 3.Department of Medical SciencesUniversity of FerraraFerraraItaly
  4. 4.Department of Nuclear Medicine“Mariano Santo” HospitalCosenzaItaly

Personalised recommendations