Abstract
BackgroundSubventricular zone (SVZ) involvement is associated with a dismal prognosis in patients with glioblastoma multiforme (GBM). Dual-time point (dtp) O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET/CT (PET) may be a time- and cost-effective alternative to dynamic FET PET, but its prognostic value, particularly with respect to SVZ involvement, is unknown.MethodsThirty-five patients had two scans 5–15 and 50–60 min after i.v. FET injection to define tumor volumes and SVZ involvement before starting radiotherapy. Associations between clinical progression markers, MRI- and dtp FET PET-based tumor volumes, or SVZ involvement and progression-free (PFS) and overall survival (OS) were assessed in univariable and multivariable analyses.ResultsThe extent of resection was not related to outcomes. Albeit non-significant, dtp FET PET detected more SVZ infiltration than MRI (60% vs. 51%, p = 0.25) and was significantly associated with poor survival (p < 0.03), but PET-T1-Gad volumes were larger in this group (p < 0.002). Survival was shorter in patients with larger MRI tumor volumes, larger PET tumor volumes, and worse Karnofsky performance status (KPS), with fused PET-T1-Gad and KPS significant in multivariable analysis (p < 0.03). Uptake kinetics was not associated with treatment outcomes.ConclusionsFET PET-based tumor volumes may be useful for predicting worse prognosis glioblastoma. Although the presence of SVZ infiltration is linked to higher PET/MRI-based tumor volumes, the independent value of dtp FET PET parameters and SVZ infiltration as prognostic markers pre-irradiation has not been confirmed.
Highlights
Subventricular zone (SVZ) involvement is associated with a dismal prognosis in patients with glioblastoma multiforme (GBM)
Progression-free survival and overall survival Better Karnofsky performance status (KPS) performance status (> 70%) had a favorable impact on progression free survival (PFS) (Kaplan-Meier test; HR 0.09, 95% CI 0.02–0.38, p = 0.001) and OS (Kaplan-Meier test; HR 0.03, 95% CI 0.007–0.11, p = 0.001; Fig. 2a and b and Additional file 1: Table S1), and was correlated with PFS (p = 0.007) and OS (p < 0.001) as assessed by Spearman’s rank correlations (Additional file 1: Table S2A)
Here we show that pre-irradiation tumor volumes have a prognostic impact in GBM
Summary
Subventricular zone (SVZ) involvement is associated with a dismal prognosis in patients with glioblastoma multiforme (GBM). 2 gene mutations [6, 7], and subventricular zone (SVZ) involvement [8]. The relationship between pre-irradiation MRI contrast enhancement-based tumor volume and clinical outcome remains controversial [9, 10]. Accurately predicting tumor behavior in individual patients based on imaging parameters remains challenging, especially when molecular-genetic factors are not available. SVZ infiltration defined by MRI is known to be associated with treatment outcomes and progression and is thought to arise from neural stem cells [14, 15]. Imaging parameters that more accurately define prognosis are still urgently needed to individualize treatment
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