Abstract
Simple SummaryRecurrence after initial treatments is an expected event in glioma patients, particularly for high-grade glioma, with a median progression-free survival of 8–11 weeks. The prognostic evaluation of disease is a crucial step in the planning of therapeutic strategies, in both the primary and recurrence stages of disease. The aim of our retrospective study was to assess the prognostic value of 11C-methionine PET-CT dynamic and semiquantitative parameters in patients with suspected glioma recurrence at MR, in terms of progression-free survival and overall survival. In a population of sixty-seven consecutive patients, both static and kinetic analyses provided parameters (i.e., tumour-to-background ratio and SUVmax associated with time-to-peak, respectively) able to predict both progression-free and overall survival in the whole population and in the high-grade glioma subgroup of patients. Dynamic 11C-methionine PET-CT can be a useful diagnostic tool, in patients with suspicion of glioma recurrence, able to produce significant prognostic indices.Purpose: The prognostic evaluation of glioma recurrence patients is important in the therapeutic management. We investigated the prognostic value of 11C-methionine PET-CT (MET-PET) dynamic and semiquantitative parameters in patients with suspected glioma recurrence. Methods: Sixty-seven consecutive patients who underwent MET-PET for suspected glioma recurrence at MR were retrospectively included. Twenty-one patients underwent static MET-PET; 46/67 underwent dynamic MET-PET. In all patients, SUVmax, SUVmean and tumour-to-background ratio (T/B) were calculated. From dynamic acquisition, the shape and slope of time-activity curves, time-to-peak and its SUVmax (SUVmaxTTP) were extrapolated. The prognostic value of PET parameters on progression-free (PFS) and overall survival (OS) was evaluated using Kaplan–Meier survival estimates and Cox regression. Results: The overall median follow-up was 19 months from MET-PET. Recurrence patients (38/67) had higher SUVmax (p = 0.001), SUVmean (p = 0.002) and T/B (p < 0.001); deceased patients (16/67) showed higher SUVmax (p = 0.03), SUVmean (p = 0.03) and T/B (p = 0.006). All static parameters were associated with PFS (all p < 0.001); T/B was associated with OS (p = 0.031). Regarding kinetic analyses, recurrence (27/46) and deceased (14/46) patients had higher SUVmaxTTP (p = 0.02, p = 0.01, respectively). SUVmaxTTP was the only dynamic parameter associated with PFS (p = 0.02) and OS (p = 0.006). At univariate analysis, SUVmax, SUVmean, T/B and SUVmaxTTP were predictive for PFS (all p < 0.05); SUVmaxTTP was predictive for OS (p = 0.02). At multivariate analysis, SUVmaxTTP remained significant for PFS (p = 0.03). Conclusion: Semiquantitative parameters and SUVmaxTTP were associated with clinical outcomes in patients with suspected glioma recurrence. Dynamic PET-CT acquisition, with static and kinetic parameters, can be a valuable non-invasive prognostic marker, identifying patients with worse prognosis who require personalised therapy.
Highlights
Gliomas represent about 50% of primary brain tumours, with the majority of them presenting as or evolving to a high-grade glioma (HGG)
The aim of our study was to investigate the prognostic value of kinetic parameters extracted from dynamic 11 CMET PET-CT in patients with suspected recurrence of glioma, in terms of progression-free survival and overall survival
We retrospectively analysed the 11 C-methionine PET-CT scans (MET-PET) of 67 consecutive patients (40 males/27 females; mean age: 48 ± 15 years) with a history of previously treated glioma who were referred between December 2013 and December 2018 to our institution for suspected recurrence at MR
Summary
Gliomas represent about 50% of primary brain tumours, with the majority of them presenting as or evolving to a high-grade glioma (HGG). Recurrence after initial treatments is an expected event in glioma patients, for HGG with a median progressionfree survival of 8–11 weeks [1]. Despite the advances of several diagnostic tools and a multidisciplinary treatment approach with standard therapies, the prognosis of glioma patients, of HGG, is generally poor. The prognostic evaluation of disease is a crucial step in the planning of therapeutic strategies, in both the primary and recurrence stages of the disease. It is well known that the main clinical and molecular prognostic factors for glioma are age, histopathologic type, presence of neurological deficits, Karnofsky performance status score, isocitrate dehydrogenase (IDH) status and 1p/19q co-deletion, along with tumour size, World Health Organisation (WHO) grading and surgical aggressiveness [2,3]. Structural MR gives additional prognostic information, including preoperative tumour characteristics, such as sub-ependymal spreading and post-operative extent of resection [4,5,6]
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