Prognostic implications of Cu-diacetyl-bis (N-methylthiosemicarbazone) PET/CT in patients with glioma.

OBJECTIVE

The potential of positron emission tomography/computed tomography using Cu-diacetyl-bis (N-methylthiosemicarbazone) (Cu-ATSM PET/CT), which was originally developed as a hypoxic tracer, to predict therapeutic resistance and prognosis has been reported in various cancers. Our purpose was to investigate prognostic value of Cu-ATSM PET/CT in patients with glioma, compared to PET/CT using 2-deoxy-2-[F]fluoro-D-glucose (F-FDG).

METHOD

56 patients with glioma of World Health Organization grade 2-4 were enrolled. All participants had undergone both Cu-ATSM PET/CT and F-FDG PET/CT within mean 33.5 days prior to treatment. Maximum standardized uptake value and tumor/background ratio were calculated within areas of increased radiotracer uptake. The prognostic significance for progression-free survival and overall survival were assessed by log-rank test and Cox's proportional hazards model.

RESULTS

Disease progression and death were confirmed in 37 and 27 patients in follow-up periods, respectively. In univariate analysis, there was significant difference of both progression-free survival and overall survival in age, tumor grade, history of chemoradiotherapy, maximum standardized uptake value and tumor/background ratio calculated using Cu-ATSM PET/CT. Multivariate analysis revealed that maximum standardized uptake value calculated using Cu-ATSM PET/CT was an independent predictor of both progression-free survival and overall survival (p < 0.05). In a subgroup analysis including patients of grade 4 glioma, only the maximum standardized uptake values calculated using Cu-ATSM PET/CT showed significant difference of progression-free survival (p < 0.05).

CONCLUSIONS

Cu-ATSM PET/CT is a more promising imaging method to predict prognosis of patients with glioma compared to F-FDG PET/CT.