Identification of time-to-peak on dynamic 18F-FET-PET as a prognostic marker specifically in IDH1/2 mutant diffuse astrocytoma. Issue 2 (14th August 2017)

• Record Type: Journal Article
• Authors: Suchorska, Bogdana; Giese, Armin; Biczok, Annamaria; Unterrainer, Marcus; Weller, Michael; Drexler, Mark; Bartenstein, Peter; Schüller, Ulrich; Tonn, Jörg-Christian; Albert, Nathalie L
• Is Part Of: Neuro-oncology. Volume 20:Issue 2(2018)
• Page Start: 279
• Page End: 288
• Publication Date: 2017-08-14
• Subjects: glioma -- IDH1/2 mutation -- 1p/19q co-deletion -- 18F-FET-PET -- kinetic analysis -- prognostic value; Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/nox153
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: Background: Stratification of glioma according to isocitrate dehydrogenase 1/2 ( IDH1/2 ) mutation and 1p/19q codeletion status has gained major importance in the new World Health Organization (WHO) classification. Parameters derived from uptake dynamics of 18 F-fluoro-ethyl-tyrosine PET ( 18 F-FET-PET) such as minimal time-to-peak (TTPmin ) allow discrimination between different prognostic glioma subgroups, too. The present study is aimed at exploring whether TTPmin analysis provides prognostic information beyond the WHO classification. Methods: Three hundred patients with newly diagnosed WHO 2007 grades II–IV gliomas with 18 F-FET-PET imaging at diagnosis were grouped into 4 subgroups ( IDH1/2 mut–1p/19q codel; IDH1/2 mut–1p/19q non-codel; IDH1/2 wildtype WHO grade II and III tumors; and glioblastoma). Clinical and imaging factors such as age, Karnofsky performance score, treatment, TTPmin, and maximal tumor-to-brain ratio (TBRmax ) were analyzed with regard to progression-free and overall survival (PFS and OS) via univariate and multivariate regression analysis. Results: PFS and OS were longest in the IDH1/2 mut–1p/19q codel subgroup, followed by IDH1/2 mut–1p/19q non-codel, IDH1/2 wildtype, and GBM ( P < 0.001). Further, outcome stratified by TTPmin with a cutoff of 17.5 minutes revealed significantly longer PFS and OS in patients with TTPmin >17.5 minutes ( P < 0.001 for PFS and OS). Lower TBRmax values or the absence of 18 F-FET uptake was also associated with favorable outcome in the entire group. In the subgroup analyses, longer median TTPmin was associated with improved outcome specifically in the IDH1/2 mut–1p/19q non-codel group. Conclusion: 18 F-FET-PET–derived dynamic analysis defines prognostically distinct subgroups of IDH1/2 mutant–1p/19q non-codel gliomas which cannot be distinguished as yet by molecular marker analysis.