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01-04-2017 | Original Article

Prognostic value of post-treatment metabolic tumor volume from ¹¹C-methionine PET/CT in recurrent malignant glioma

Authors: Tae-Young Jung, Jung-Joon Min, Hee-Seung Bom, Shin Jung, In-Young Kim, Sa-Hoe Lim, Dong-Yeon Kim, Seong Young Kwon

Published in: Neurosurgical Review | Issue 2/2017

Abstract

We investigated the diagnostic and prognostic significance of metabolic parameters from ¹¹C-methionine (MET) positron emission tomography (PET) in patients with malignant glioma. The MET-PET was examined in 42 patients who had been previously treated with adjuvant treatment for malignant glioma. Both ratios of maximal MET uptake of the tumors to those of the contralateral normal gray matter (T/N ratio) and metabolic tumor volume (MTV) were estimated in each lesion. The diagnostic performance for recurrence was investigated in all enrolled patients. A definitive diagnosis was done with pathologic confirmation or clinical follow-up. Among recurrent patients, we evaluated the prognostic value of metabolic parameters (T/N ratio and MTV) as well as clinical factors. Among 42 patients, 35 patients were revealed with recurrence. Both T/N ratios (p = 0.009) and MTV (p = 0.001) exhibited statistical significance to differentiate between recurrence and post-treatment radiation effect. A T/N ratio of 1.43 provided the best sensitivity and specificity for recurrence (91.4 and 100 %, respectively), and a MTV of 6.72 cm³ provided the best sensitivity and specificity (77.1 % and 100 %, respectively). To evaluate the prognostic impact, different cutoffs of MTV were examined in patients with recurrent tumor and a threshold of 60 cm³ was determined as a best cutoff value to separate the patients in two prognostic groups. Univariate analysis revealed improved overall survival (OS) for patients with Karnofsky performance scale (KPS) score ≥70 (p < 0.001) or MTV <60 cm³ (p = 0.049). Multivariate analysis showed that patients with KPS score ≥70 (p < 0.001; hazard ratio = 0.104; 95 % CI, 0.029–0.371) or MTV < 60 cm³ (p = 0.031; hazard ratio = 0.288; 95 % CI, 0.093–0.895) were significantly associated with a longer OS. However, T/N ratio was not correlated with patients’ outcome. Metabolic parameters had the diagnostic value to differentiate recurrence from post-treatment radiation effect. Compared with T/N ratio, MTV was an independent significant prognostic factor with KPS score in patients with recurrent tumor. Our study had a potential to manage these patients according to prognostic information using MET-PET.

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Title: Prognostic value of post-treatment metabolic tumor volume from 11C-methionine PET/CT in recurrent malignant glioma
Authors: Tae-Young Jung
Jung-Joon Min
Hee-Seung Bom
Shin Jung
In-Young Kim
Sa-Hoe Lim
Dong-Yeon Kim
Seong Young Kwon
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 2/2017
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-016-0748-1

At a glance: The STEP trials

Springer Medicine

Prognostic value of post-treatment metabolic tumor volume from ¹¹C-methionine PET/CT in recurrent malignant glioma

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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