Abstract
PurposeThe value of O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-positron emission tomography (PET)-radiomics in the outcome assessment of patients with recurrent glioblastoma (rGBM) has not been evaluated until now. The aim of this study was to evaluate whether a prognostic model based on FET-PET radiomics features (RF) is feasible and can identify rGBM patients that would most benefit from re-irradiation.MethodsWe prospectively recruited rGBM patients who underwent FET-PET before re-irradiation (GLIAA-Pilot trial, DRKS00000633). Tumor volume was delineated using a semi-automatic method with a threshold of 1.8 times the standardized-uptake-value of the background. 135 FET-RF (histogram parameters, shape and texture features) were extracted. The analysis involved the characterization of tumor and non-tumor tissue with FET-RF and the evaluation of the prognostic value of FET-RF for time-to-progression (TTP), overall survival (OS) and recurrence location (RL).ResultsThirty-two rGBM patients constituted our cohort. FET-RF discriminated significantly between tumor and non-tumor. The texture feature Small-Zone-Low-Gray-Level-Emphasis (SZLGE) showed the best performance for the prediction of TTP (p = 0.001, satisfying Bonferroni-multiple-test significance level). Additionally, two radiomics signatures could predict TTP (TTP-radiomics-signature, p = 0.001) and OS (OS-radiomics-signature, p = 0.038). SZLGE and the TTP-radiomics-signature additionally predicted RL. Specifically, high values for TTP-radiomics-signature and for SZLGE indicated not only earlier progression, but also a RL within the initial FET-PET active volume.ConclusionOur findings suggest that FET-PET radiomics could contribute to the prognostic assessment and selection of rGBM-patients benefiting from re-irradiation.Trial registration DRKS00000633. Registered on 8th of December in 2010.https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00000633.
Highlights
Surgery, radiation therapy (RT) and chemotherapy is the standard treatment in glioblastoma (GBM) [1]
Our findings suggest that FET-positron emission tomography (PET) radiomics could contribute to the prognostic assessment and selec‐ tion of recurrent glioblastoma (rGBM)-patients benefiting from re-irradiation
The aim of the current study was to assess the feasibility of developing a model based on FET radiomics features (RF), with the objective of selecting rGBM patients that would most benefit from re-irradiation
Summary
Radiation therapy (RT) and chemotherapy is the standard treatment in glioblastoma (GBM) [1]. In recurrent glioblastoma (rGBM), re-irradiation (re-RT) is an important therapeutic alternative, which may delay further disease progression and improve survival [2, 3]. Diagnosis, treatment planning and followup of GBM are based on magnetic resonance imaging (MRI): gadolinium contrast enhanced T1-weighted images (Gd-T1MR), T2 images, FLAIR images etc. Contrast enhancement could occur after a recent surgery, RT or chemotherapy (pseudoprogression). In this case, amino-acid positron emission tomography (PET) has been proven to be able to non-invasively differentiate treatment-related changes from real tumor progression [8,9,10]. The use of the radiolabeled amino acid O-(2-[18F] fluoroethyl)-L-tyrosine (FET) has rapidly increased in the last decade [9,10,11,12,13,14]
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