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Prognostic value of pretreatment 18F-FDG PET in patients with primary central nervous system lymphoma: SUV-based assessment

Journal of Neuro-Oncology volume 100, pages 225–232 (2010)Cite this article

Abstract

The purpose of this retrospective study was to evaluate the prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in immunocompetent patients with primary central nervous system lymphoma (PCNSL). We also investigated whether FDG uptake was related to angiogenesis in the tumors. Seventeen patients with newly diagnosed and histologically confirmed PCNSL were investigated with FDG-PET before the treatment. FDG uptake was assessed by standardized uptake value of the tumor showing the maximum uptake (SUVmax). The Kaplan–Meier method was used to estimate the overall and the progression-free survival times. The difference of the survival curves between the low to moderate FDG uptake (SUVmax < 12) and high FDG uptake (SUVmax ≥ 12) groups was statistically analyzed. The relationship between FDG SUVmax and microvessel density (MVD) in the tumor specimens determined by CD34 immunohistochemical staining was examined. Finally, the difference of the overall survival curve between the low MVD (<20) and high MVD (≥20) groups was statistically analyzed. After the completion of initial treatment, 7 of the 8 low to moderate FDG uptake patients showed complete response (CR) and 1 showed partial response (PR). On the other hand, 5 of the 9 high FDG uptake patients showed CR and 4 showed PR. However, the difference of treatment response (CR vs PR) between the low to moderate and high FDG uptake groups was not statistically significant (P = 0.36). Median survival time was more than 26 months in low to moderate FDG uptake patients and 12 months in high FDG uptake patients. The overall survival time of patients with low to moderate FDG uptake was significantly longer than that of patients with high FDG uptake (P < 0.05). The progression free survival (PFS) was also significantly longer in patients with low to moderate FDG uptake compared to the patients with high FDG uptake (P < 0.05). There was no significant relationship between FDG SUVmax and MVD in the tumors. The survival time tended to be longer in patients with high MVD than in low MVD, but the difference was not statistically significant (P = 0.15). Pretreatment FDG uptake may have a prognostic value in newly diagnosed PCNSL.

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References

  1. Calli C, Kitis O, Yunten N, Yurtseven T, Islekel S, Akalin T (2006) Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol 58:394–403

    Article  PubMed  Google Scholar 

  2. Ceyssens S, Van Laere K, de Groot T, Goffin J, Bormans G, Mortelmans L (2006) [11C]methionine PET, histopathology, and survival in primary brain tumors and recurrence. Am J Neuroradiol 27:1432–1437

    CAS  PubMed  Google Scholar 

  3. Corry J, Smith JG, Wirth A, Quong G, Liew KH (1998) Primary central nervous system lymphoma: age and performance status are more important than treatment modality. Int J Radiat Oncol Biol Phys 41:615–620

    Article  CAS  PubMed  Google Scholar 

  4. DeAngelis LM, Seiferheld W, Schold SC, Fisher B, Schultz CJ (2002) Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group Study 93–10. J Clin Oncol 20:4643–4648

    Article  PubMed  Google Scholar 

  5. Di Chiro G, DeLaPaz RL, Brooks RA, Sokoloff L, Kornblith PL, Smith BH, Patronas NJ, Kufta CV, Kressler RM, Johnston GS, Manning RG, Wolf AP (1982) Glucose utilization of cerebral gliomas measured by [18F] fluorodeoxyglucose and positron emission tomography. Neurology 32:1323–1329

    CAS  PubMed  Google Scholar 

  6. Ferreri AJ, Blay JY, Reni M, Pasini F, Spina M, Ambrosetti A, Calderoni A, Rossi A, Vavassori V, Conconi A, Devizzi L, Berger F, Ponzoni M, Borisch B, Tinguely M, Cerati M, Milani M, Orvieto E, Sanchez J, Chevreau C, Dell’Oro S, Zucca E, Cavalli F (2003) Prognostic scoring system for primary CNS lymphomas: the International Extranodal Lymphoma Study Group experience. J Clin Oncol 21:266–272

    Article  PubMed  Google Scholar 

  7. Gavrilovic IT, Hormigo A, Yahalom J, DeAngelis LM, Abrey LE (2006) Long-term follow-up of high-dose methotrexate-based therapy with and without whole brain irradiation for newly diagnosed primary CNS lymphoma. J Clin Oncol 24:4570–4574

    Article  CAS  PubMed  Google Scholar 

  8. Guha-Thakurta N, Damek D, Pollack C, Hochberg FH (1999) Intravenous methotrexate as initial treatment for primary central nervous system lymphoma: response to therapy and quality of life of patients. J Neurooncol 43:259–268

    Article  CAS  PubMed  Google Scholar 

  9. Haioun C, Itti E, Rahmouni A, Brice P, Rain JD, Belhadj K, Gaulard P, Garderet L, Lepage E, Reyes F, Meignan M (2005) [18f]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting patient outcome. Blood 106:1376–1381

    Article  CAS  PubMed  Google Scholar 

  10. Haldorsen IS, Kråkenes J, Krossnes BK, Mella O, Espeland A (2009) CT and MRI imaging features of primary central nervous system lymphoma in Norway, 1989–2003. Am J Neuroradiol 30:744–751

    Article  CAS  PubMed  Google Scholar 

  11. Hartmann M, Heiland S, Harting I, Tronnier VM, Sommer C, Ludwig R, Sartor K (2003) Distinguishing of primary cerebral lymphoma from high-grade glioma with perfusion-weighted magnetic resonance imaging. Neurosci Lett 338:119–122

    Article  CAS  PubMed  Google Scholar 

  12. Hatakeyama T, Kawai N, Nishiyama Y, Yamamoto Y, Sasakawa Y, Ichikawa T, Tamiya T (2008) 11C-methionine (MET) and 18F-fluorothymidine (FLT) PET in patients with newly diagnosed glioma. Eur J Nucl Med Mol Imaging 35:2009–2017

    Article  CAS  PubMed  Google Scholar 

  13. Hayabuchi N, Shibamoto Y, Onizuka Y (1999) Primary central nervous system lymphoma in Japan: a nationwide survey. Int J Radiat Oncol Biol Phys 44:265–272

    CAS  PubMed  Google Scholar 

  14. Karantanis D, O’Neill BP, Subramaniam RM, Witte RJ, Mullan BP, Nathan MA, Lowe VJ, Peller PJ, Wiseman GA (2007) 18F-FDG PET/CT in primary central nervous system lymphoma in HIV-negative patients. Nucl Med Commun 28:834–841

    Article  PubMed  Google Scholar 

  15. Kawai N, Nishiyama Y, Miyake K, Tamiya T, Nagao S (2005) Evaluation of tumor FDG transport and metabolism in primary central nervous system lymphoma using [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) kinetic analysis. Ann Nucl Med 19:685–690

    Article  PubMed  Google Scholar 

  16. Kim S, Chung JK, Im SH, Jeong JM, Lee DS, Kim DG, Jung HW, Lee MC (2005) 11C-methionine PET as a prognostic marker in patients with glioma: comparison with 18F-FDG PET. Eur J Nucl Med Mol Imaging 32:52–59

    Article  CAS  PubMed  Google Scholar 

  17. Kostakoglu L, Coleman M, Leonard JP, Kuji I, Zoe H, Goldsmith SJ (2002) PET predicts prognosis after 1 cycle of chemotherapy in aggressive lymphoma and Hodgkin’s Disease. J Nucl Med 43:1018–1027

    PubMed  Google Scholar 

  18. Kracht LW, Friese M, Herholz K, Schroeder R, Bauer B, Jacobs A, Heiss WD (2003) Methyl-[11C]-L-methionine uptake as measured by positron emission tomography correlates to microvessel density in patients with glioma. Eur J Nucl Med Mol Imaging 30:868–873

    Article  CAS  PubMed  Google Scholar 

  19. Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T (1992) Intratumoral distribution of fluorine-18-fluorodeoxy glucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 33:1972–1980

    CAS  PubMed  Google Scholar 

  20. Liao W, Liu Y, Wang X, Jiang X, Tang B, Fang J, Chen C, Hu Z (2009) Differentiation of primary central nervous system lymphoma and high-grade glioma with dynamic susceptibility contrast enhanced perfusion magnetic resonance imaging. Acta Radiol 50:217–225

    Article  PubMed  Google Scholar 

  21. Lin C, Itti E, Haioun C, Petegnief Y, Luciani A, Dupuis J, Paone G, Talbot JN, Rahmouni A, Meignan M (2007) Early 18F-FDG PET for prediction of prognosis in patients with diffuse large B-cell lymphoma: SUV-base assessment versus visual analysis. J Nucl Med 48:1626–1632

    Article  PubMed  Google Scholar 

  22. Mohile NA, DeAngelis LM, Abrey LE (2008) Utility of brain FDG-PET in primary CNS lymphoma. Clin Adv Hematol Oncol 6:818–820, 840

    Google Scholar 

  23. Nelson DF, Martz KL, Bonner H, Nelson JS, Newall J, Kerman HD, Thomson JW, Murray KJ (1992) Non-Hodgkin’s lymphoma of the brain: can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys 23:9–17

    CAS  PubMed  Google Scholar 

  24. Nishiyama Y, Yamamoto Y, Monden T, Sasakawa Y, Kawai N, Satho K, Ohkawa M (2007) Diagnostic value of kinetic analysis using dynamic FDG PET in immunocompetent patients with primary CNS lymphoma. Eur J Nucl Med Mol Imaging 34:78–86

    Article  PubMed  Google Scholar 

  25. O’Brien P, Roos D, Pratt G, Liew K, Barton M, Poulsen M, Olver I, Trotter G (2000) Phase II multicenter study of brief single-agent methotrexate followed by irradiation in primary CNS lymphoma. J Clin Oncol 18:519–526

    PubMed  Google Scholar 

  26. O’Doherty MJ, Barrington SF, Campbell M, Lowe J, Bradbeer CS (1997) PET scanning and the human immunodeficiency virus-positive patient. J Nucl Med 38:1575–1583

    PubMed  Google Scholar 

  27. Padma MV, Said S, Jacobs M, Hwang DR, Dunigan K, Satter M, Christian B, Ruppert J, Bernstein T, Kraus G, Mantil JC (2003) Prediction of pathology and survival by FDG PET in gliomas. J Neurooncol 64:227–237

    Article  CAS  PubMed  Google Scholar 

  28. Palmedo H, Urbach H, Bender H, Schlegel U, Schmidt-Wolf IG, Matthies A, Linnebank M, Joe A, Bucerius J, Biersack HJ, Pels H (2006) FDG-PET in immunocompetent patients with primary central nervous system lymphoma: correlation with MRI and clinical follow-up. Eur J Nucl Med Mol Imaging 33:164–168

    Article  CAS  PubMed  Google Scholar 

  29. Roelcke U, Leenders KL (1999) Positron emission tomography in patients with primary CNS lymphoma. J Neurooncol 43:231–236

    Article  CAS  PubMed  Google Scholar 

  30. Rosenfeld SS, Hoffman JM, Coleman RE, Glantz MJ, Hanson MW, Schold SC (1992) Studies of primary central nervous system lymphoma with fluorine-18-fluorodeoxyglucose positron emission tomography. J Nucl Med 33:532–536

    CAS  PubMed  Google Scholar 

  31. Shibamoto Y, Ogino H, Suzuki G, Takemoto M, Araki N, Isobe K, Tsuchida E, Nakamura K, Kenjo M, Suzuki K, Hosono M, Tokumaru S, Ishihara S, Kato E, Ii N, Hayabuchi N (2008) Primary central nervous system lymphoma in Japan: changes in clinical features, treatment, and prognosis during 1985–2004. Neuro Oncol 10:560–568

    Article  PubMed  Google Scholar 

  32. Takeuchi H, Matsuda K, Kitai R, Sato K, Kubota T (2007) Angiogenesis in primary central nervous system lymphoma (PCNSL). J Neurooncol 84:141–145

    Article  PubMed  Google Scholar 

  33. Tateishi U, Nishihara H, Tsukamoto E, Morikawa T, Tamaki N, Miyasaka K (2002) Lung tumors evaluated with FDG-PET and dynamic CT: the relationship between vascular density and glucose metabolism. J Comput Assist Tomogr 26:185–190

    Article  PubMed  Google Scholar 

  34. Torizuka T, Nakamura F, Kanno T, Futatsubashi M, Yoshikawa E, Okada H, Kobayashi M, Ouchi Y (2004) Early therapy monitoring with FDG-PET in aggressive non-Hodgkin’s lymphoma and Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging 31:22–28

    Article  PubMed  Google Scholar 

  35. Zhen HN, Zhang X, Hu PZ, Yang TT, Fei Z, Zhang JN, Fu LA, He XS, Ma FC, Wang XL (2005) Surviving expression and its relation with proliferation, apoptosis, and angiogenesis in brain gliomas. Cancer 104:2775–2783

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Nobuyuki Kawai, Hai-Ning Zhen, Keisuke Miyake & Takashi Tamiya

  2. Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China

    Hai-Ning Zhen

  3. Department of Radiology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan

    Yuka Yamamaoto & Yoshihiro Nishiyama

Authors
  1. Nobuyuki Kawai
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  2. Hai-Ning Zhen
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  3. Keisuke Miyake
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  4. Yuka Yamamaoto
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Correspondence to Nobuyuki Kawai.

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Kawai, N., Zhen, HN., Miyake, K. et al. Prognostic value of pretreatment 18F-FDG PET in patients with primary central nervous system lymphoma: SUV-based assessment. J Neurooncol 100, 225–232 (2010). https://doi.org/10.1007/s11060-010-0182-0

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  • DOI: https://doi.org/10.1007/s11060-010-0182-0

Keywords

  • Primary central nervous system lymphoma
  • 18F-fluorodeoxyglucose (FDG)
  • Positron emission tomography (PET)
  • Prognosis