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Title of the item:

Early treatment response evaluation using FET PET compared to MRI in glioblastoma patients at first progression treated with bevacizumab plus lomustine.

Title :
Early treatment response evaluation using FET PET compared to MRI in glioblastoma patients at first progression treated with bevacizumab plus lomustine.
Authors :
Dunkl, Veronika
Ceccon, Garry
Steger, Jan
Bauer, Elena K.
Tscherpel, Caroline
Fink, Gereon R.
Galldiks, Norbert
Stoffels, Gabriele
Lohmann, Philipp
Shah, Nadim J.
Langen, Karl-Josef
Law, Ian
Henriksen, Otto M.
Muhic, Aida
Poulsen, Hans S.
Schmidt, Matthias
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Subject Terms :
GLIOMA treatment
TYROSINE
BEVACIZUMAB
MAGNETIC resonance imaging
POSITRON emission
CANCER invasiveness
Source :
European Journal of Nuclear Medicine & Molecular Imaging; Dec2018, Vol. 45 Issue 13, p2377-2386, 10p, 1 Diagram, 4 Charts, 2 Graphs
Academic Journal
Background: The goal of this prospective study was to compare the value of both conventional MRI and O-(2-18F-fluoroethyl)-L-tyrosine (FET) PET for response evaluation in glioblastoma patients treated with bevacizumab plus lomustine (BEV/LOM) at first progression.Methods: After chemoradiation with concomitant and adjuvant temozolomide, 21 IDH wild-type glioblastoma patients at first progression (age range, 33-75 years; MGMT promoter unmethylated, 81%) were treated with BEV/LOM. Contrast-enhanced MRI and FET-PET scans were performed at baseline and after 8-10 weeks. We obtained FET metabolic tumor volumes (MTV) and tumor/brain ratios. Threshold values of FET-PET parameters for treatment response were established by ROC analyses using the post-progression overall survival (OS) ≤/>9 months as the reference. MRI response assessment was based on RANO criteria. The predictive ability of FET-PET thresholds and MRI changes on early response assessment was evaluated subsequently concerning OS using uni- and multivariate survival estimates.Results: Early treatment response as assessed by RANO criteria was not predictive for an OS>9 months (P = 0.203), whereas relative reductions of all FET-PET parameters significantly predicted an OS>9 months (P < 0.05). The absolute MTV at follow-up enabled the most significant OS prediction (sensitivity, 85%; specificity, 88%; P = 0.001). Patients with an absolute MTV below 5 ml at follow-up survived significantly longer (12 vs. 6 months, P < 0.001), whereas early responders defined by RANO criteria lived only insignificantly longer (9 vs. 6 months; P = 0.072). The absolute MTV at follow-up remained significant in the multivariate survival analysis (P = 0.006).Conclusions: FET-PET appears to be useful for identifying responders to BEV/LOM early after treatment initiation. [ABSTRACT FROM AUTHOR]
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