Universität zu Köln

Werner, Jan-Michael ORCID: 0000-0001-7147-4594, Weller, Johannes, Ceccon, Garry, Schaub, Christina, Tscherpel, Caroline, Lohmann, Philipp ORCID: 0000-0002-5360-046X, Bauer, Elena K., Schaefer, Niklas, Stoffels, Gabriele, Baues, Christian, Celik, Eren, Marnitz, Simone, Kabbasch, Christoph, Gielen, Gerrit H., Fink, Gereon R. ORCID: 0000-0002-8230-1856, Langen, Karl-Josef, Herrlinger, Ulrich and Galldiks, Norbert (2021). Diagnosis of Pseudoprogression Following Lomustine-Temozolomide Chemoradiation in Newly Diagnosed Glioblastoma Patients Using FET-PET. Clin. Cancer Res., 27 (13). S. 3704 - 3714. PHILADELPHIA: AMER ASSOC CANCER RESEARCH. ISSN 1557-3265

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Abstract

Purpose The CeTeG/NOA-09 phase III trial demonstrated a significant survival benefit of lomustine-temozolomide chemoradiation in patients with newly diagnosed glioblastoma with methylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter. Following lomustine-temozolomide chemoradiation, late and prolonged pseudoprogression may occur. We here evaluated the value of amino acid PET using O-(2[F-18]fluoroethyl)-L-tyrosine (FET) for differentiating pseudoprogression from tumor progression. Experimental Design: We retrospectively identified patients (i) who were treated off-study according to the CeTeG/NOA-09 protocol, (ii) had equivocal MRI findings after radiotherapy, and (iii) underwent additional FET-PET imaging for diagnostic evaluation (number of scans, 1-3). Maximum and mean tumor-to-brain ratios (TBRmax, TBRmean) and dynamic FET uptake parameters mean, (e.g., time-to-peak) were calculated. In patients with more than one FET-PET scan, relative changes of TBR values were evaluated, that is, an increase or decrease of >10% compared with the reference scan was considered as tumor progression or pseudoprogression. Diagnostic performances were evaluated using ROC curve analyses and Fisher exact test. Diagnoses were confirmed histologically or clinicoradiologically. Results: We identified 23 patients with 32 FET-PET scans. Within 5-25 weeks after radiotherapy (median time, 9 weeks), pseudoprogression occurred in 11 patients (48%). The parameter TBRmean calculated from the FET-PET performed 10 +/- 7 days after the equivocal MRI showed the highest accuracy (87%) to identify pseudoprogression (threshold, <1.95; P = 0.029). The integration of relative changes of TBRmean further improved the accuracy (91%; P < 0.001). Moreover, the combination of static and dynamic parameters increased the specificity to 100% (P = 0.005). Conclusions: The data suggest that FET-PET parameters are of significant clinical value to diagnose pseudoprogression related to lomustine-temozolomide chemoradiation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Werner, Jan-Michael UNSPECIFIED orcid.org/0000-0001-7147-4594 UNSPECIFIED Weller, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Ceccon, Garry UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaub, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Tscherpel, Caroline UNSPECIFIED UNSPECIFIED UNSPECIFIED Lohmann, Philipp UNSPECIFIED orcid.org/0000-0002-5360-046X UNSPECIFIED Bauer, Elena K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Niklas UNSPECIFIED UNSPECIFIED UNSPECIFIED Stoffels, Gabriele UNSPECIFIED UNSPECIFIED UNSPECIFIED Baues, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Celik, Eren UNSPECIFIED UNSPECIFIED UNSPECIFIED Marnitz, Simone UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabbasch, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Gielen, Gerrit H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fink, Gereon R. UNSPECIFIED orcid.org/0000-0002-8230-1856 UNSPECIFIED Langen, Karl-Josef UNSPECIFIED UNSPECIFIED UNSPECIFIED Herrlinger, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Galldiks, Norbert UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-594835
DOI:	10.1158/1078-0432.CCR-21-0471
Journal or Publication Title:	Clin. Cancer Res.
Volume:	27
Number:	13
Page Range:	S. 3704 - 3714
Date:	2021
Publisher:	AMER ASSOC CANCER RESEARCH
Place of Publication:	PHILADELPHIA
ISSN:	1557-3265
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MGMT PROMOTER METHYLATION; O-(2-F-18-FLUOROETHYL)-L-TYROSINE PET; ADJUVANT TEMOZOLOMIDE; RESPONSE ASSESSMENT; RADIOTHERAPY; BRAIN; CONCURRENT; MUTATION; GLIOMAS; CLASSIFICATION Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59483