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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-12-2018 | Original Article

Serial FLT PET imaging to discriminate between true progression and pseudoprogression in patients with newly diagnosed glioblastoma: a long-term follow-up study

Authors: Cyrillo G. Brahm, Martha W. den Hollander, Roelien H. Enting, Jan Cees de Groot, A. Millad Solouki, Wilfred F. A. den Dunnen, Mart A. A. M. Heesters, Michiel Wagemakers, Henk M. W. Verheul, Elisabeth G. E. de Vries, Jan Pruim, Annemiek M. E. Walenkamp

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 13/2018

Abstract

Purpose

Response evaluation in patients with glioblastoma after chemoradiotherapy is challenging due to progressive, contrast-enhancing lesions on MRI that do not reflect true tumour progression. In this study, we prospectively evaluated the ability of the PET tracer ¹⁸F-fluorothymidine (FLT), a tracer reflecting proliferative activity, to discriminate between true progression and pseudoprogression in newly diagnosed glioblastoma patients treated with chemoradiotherapy.

Methods

FLT PET and MRI scans were performed before and 4 weeks after chemoradiotherapy. MRI scans were also performed after three cycles of adjuvant temozolomide. Pseudoprogression was defined as progressive disease on MRI after chemoradiotherapy with stabilisation or reduction of contrast-enhanced lesions after three cycles of temozolomide, and was compared with the disease course during long-term follow-up. Changes in maximum standardized uptake value (SUV_max) and tumour-to-normal uptake ratios were calculated for FLT and are presented as the mean SUV_max for multiple lesions.

Results

Between 2009 and 2012, 30 patients were included. Of 24 evaluable patients, 7 showed pseudoprogression and 7 had true progression as defined by MRI response. FLT PET parameters did not significantly differ between patients with true progression and pseudoprogression defined by MRI. The correlation between change in SUV_max and survival (p = 0.059) almost reached the standard level of statistical significance. Lower baseline FLT PET uptake was significantly correlated with improved survival (p = 0.022).

Conclusion

Baseline FLT uptake appears to be predictive of overall survival. Furthermore, changes in SUV_max over time showed a tendency to be associated with improved survival. However, further studies are necessary to investigate the ability of FLT PET imaging to discriminate between true progression and pseudoprogression in patients with glioblastoma.

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Title: Serial FLT PET imaging to discriminate between true progression and pseudoprogression in patients with newly diagnosed glioblastoma: a long-term follow-up study
Authors: Cyrillo G. Brahm
Martha W. den Hollander
Roelien H. Enting
Jan Cees de Groot
A. Millad Solouki
Wilfred F. A. den Dunnen
Mart A. A. M. Heesters
Michiel Wagemakers
Henk M. W. Verheul
Elisabeth G. E. de Vries
Jan Pruim
Annemiek M. E. Walenkamp
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 13/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4090-4

At a glance: The STEP trials

Springer Medicine

Serial FLT PET imaging to discriminate between true progression and pseudoprogression in patients with newly diagnosed glioblastoma: a long-term follow-up study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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