Schwarzenberg Johannes, Czernin Johannes, Cloughesy Timothy F, Ellingson Benjamin M, Pope Whitney B, Grogan Tristan, Elashoff David, Geist Cheri, Silverman Daniel H S, Phelps Michael E, Chen Wei
Authors' Affiliations: Department of Molecular and Medical Pharmacology; Ahmanson Translational Imaging Division; Departments of Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Austria.
Authors' Affiliations: Department of Molecular and Medical Pharmacology; Ahmanson Translational Imaging Division; Departments of.
Clin Cancer Res. 2014 Jul 1;20(13):3550-9. doi: 10.1158/1078-0432.CCR-13-1440. Epub 2014 Mar 31.
This study compares the value of 3,4-dihydroxy-6-[(18)F]-fluoro-l-phenylalanine ((18)F-FDOPA) positron emission tomography (PET) and MRI in assessing outcome during antiangiogenic treatment in patients with recurrent high-grade gliomas.
Thirty patients were prospectively studied with (18)F-FDOPA PET scans immediately before, and two and six weeks after start of bevacizumab therapy. (18)F-FDOPA metabolic tumor volumes (MTV) as well as max and mean standardized uptake values (SUV) within this MTV were obtained. MRI treatment response was assessed at six weeks. The predictive ability of (18)F-FDOPA PET and MRI response assessment were evaluated with regard to progression-free survival (PFS) and overall survival (OS).
A total of 30, 28, and 24 (18)F-FDOPA PET scans at baseline, two weeks, and six weeks, were available for analysis, respectively. (18)F-FDOPA PET SUVs as well as their changes through therapy were not predictive of outcome. However, MTV parameters such as MTV changes were highly prognostic. Interestingly, absolute MTV at the first follow up scan provides the most significant prediction for increased OS (P < 0.0001) as well as PFS (P = 0.001). This surprising result was scrutinized with cross-validation and simulation analysis. Responders based on (18)F-FDOPA PET data survived 3.5 times longer (12.1 months vs. 3.5 months, median OS, P < 0.001) than nonresponders (17 patients vs. 11 patients, respectively). In comparison, responders based on MRI data lived 1.5 times longer (11.4 months vs 7.7 months, P = 0.03) than nonresponders (22 patients vs. 7 patients, respectively).
(18)F-FDOPA PET identifies treatment responders to antiangiogenic therapy as early as two weeks after treatment initiation.
本研究比较3,4 - 二羟基 - 6 - [(18)F] - 氟 - L - 苯丙氨酸（(18)F - FDOPA）正电子发射断层扫描（PET）和磁共振成像（MRI）在评估复发性高级别胶质瘤患者抗血管生成治疗效果方面的价值。
对30例患者进行前瞻性研究，在开始贝伐单抗治疗前、治疗开始后2周和6周分别进行(18)F - FDOPA PET扫描。获取(18)F - FDOPA代谢肿瘤体积（MTV）以及该MTV内的最大和平均标准化摄取值（SUV）。在6周时评估MRI治疗反应。就无进展生存期（PFS）和总生存期（OS）评估(18)F - FDOPA PET和MRI反应评估的预测能力。
分别有30例、28例和24例(18)F - FDOPA PET扫描可用于基线、2周和6周时的分析。(18)F - FDOPA PET的SUV及其治疗期间的变化不能预测治疗结果。然而，MTV参数如MTV变化具有高度预后价值。有趣的是，首次随访扫描时的绝对MTV对OS增加（P < 0.0001）以及PFS（P = 0.001）提供了最显著的预测。通过交叉验证和模拟分析对这一惊人结果进行了仔细研究。基于(18)F - FDOPA PET数据的反应者生存期比无反应者长3.5倍（中位OS分别为12.1个月对3.5个月，P < 0.001）（分别为17例患者对11例患者）。相比之下，基于MRI数据的反应者生存期比无反应者长1.5倍（11.4个月对7.7个月，P = 0.03）（分别为22例患者对7例患者）。
(18)F - FDOPA PET可在治疗开始后两周就识别出抗血管生成治疗的反应者。
