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SHR Neuro Cancer Cardio Lipid Metab Microb

Schwarzenberg, J; Czernin, J; Cloughesy, TF; Ellingson, BM; Pope, WB; Geist, C; Dahlbom, M; Silverman, DH; Satyamurthy, N; Phelps, ME; Chen, W.
3'-deoxy-3'-18F-fluorothymidine PET and MRI for early survival predictions in patients with recurrent malignant glioma treated with bevacizumab.
J Nucl Med. 2012; 53(1):29-36 Doi: 10.2967/jnumed.111.092387 [OPEN ACCESS]
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Leading authors Med Uni Graz: Schwarzenberg Johannes
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Abstract:: With the dismal prognosis for malignant glioma patients, survival predictions become key elements in patient management. This study compares the value of 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) PET and MRI for early outcome predictions in patients with recurrent malignant glioma on bevacizumab therapy. Thirty patients treated with bevacizumab combination therapy underwent (18)F-FLT PET immediately before and at 2 and 6 wk after the start of treatment. A metabolic treatment response was defined as a decrease of equal to or greater than 25% in tumor (18)F-FLT uptake (standardized uptake values) from baseline using receiver-operating-characteristic analysis. MRI treatment response was assessed at 6 wk according to the Response Assessment in Neurooncology criteria. (18)F-FLT responses at different times were compared with MRI response and correlated with progression-free survival and overall survival using Kaplan-Meier analysis. Metabolic response based on (18)F-FLT was further compared with other outcome predictors using Cox regression analysis. Early and late changes in tumor (18)F-FLT uptake were more predictive of overall survival than MRI criteria (P < 0.001 and P = 0.01, respectively). (18)F-FLT uptake changes were also predictive of progression-free survival (P < 0.001). The median overall survival for responders was 3.3 times longer than for nonresponders based on (18)F-FLT PET criteria (12.5 vs. 3.8 mo, P < 0.001) but only 1.4 times longer using MRI assessment (12.9 vs. 9.0 mo, P = 0.05). On the basis of the 6-wk (18)F-FLT PET response, there were 16 responders (53%) and 14 nonresponders (47%), whereas MRI identified 9 responders (7 partial response, 2 complete response, 31%) and 20 nonresponders (13 stable disease, 7 progressive disease, 69%). In 7 of the 8 discrepant cases between MRI and PET, (18)F-FLT PET was able to demonstrate response earlier than MRI. Among various outcome predictors, multivariate analysis identified (18)F-FLT PET changes at 6 wk as the strongest independent survival predictor (P < 0.001; hazard ratio, 10.051). Changes in tumor (18)F-FLT uptake were highly predictive of progression-free and overall survival in patients with recurrent malignant glioma on bevacizumab therapy. (18)F-FLT PET seems to be more predictive than MRI for early treatment response.
Find related publications in this database (using NLM MeSH Indexing): Antibodies, Monoclonal, Humanized - therapeutic use; Bevacizumab -; Biological Transport -; Dideoxynucleosides - metabolism; Disease-Free Survival -; Female -; Glioma - diagnosis Glioma - drug therapy Glioma - metabolism Glioma - pathology; Humans -; Magnetic Resonance Imaging -; Male -; Middle Aged -; Positron-Emission Tomography -; Recurrence -; Time Factors -; Treatment Outcome -
Find related publications in this database (Keywords): F-18-FLT PET; bevacizumab; malignant glioma; survival prediction