Li Li, Liu Ning, Zhang Hui, Tao Rongjie, Zhao Shuqiang, Chen Zhaoqiu, Fu Zheng, Li Wanhu, Xu Liang, Liu Yuhui, Yu Jinming, Yuan Shuanghu
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Department of Oncology, Linyi Cancer Hospital, Linyi, China.
Front Oncol. 2022 Aug 26;12:848266. doi: 10.3389/fonc.2022.848266. eCollection 2022.
To investigate the ability of potential imaging biomarkers based on F-AlF-NOTA-PRGD2 positron emission tomography/computed tomography (F-RGD PET/CT) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) imaging to predict the response to bevacizumab combined with conventional therapy in postoperative newly diagnosed glioblastoma.
Twenty patients with newly diagnosed with glioblastoma after surgery were prospectively enrolled to receive bevacizumab plus conventional concurrent radiotherapy and temozolomide (CCRT). F-RGD PET/CT and DCE-MRI were performed at baseline, week 3, and week 10 for each patient. Statistical methods included the analysis of variance (ANOVA), Kaplan-Meier method and Cox proportional hazard analysis.
All patients completed CCRT plus bevacizumab therapy without interruption. The median follow-up time was 33.9 months (95% confidence interval [CI], 28.3-39.5 months). The median progression-free survival (PFS) and overall survival (OS) was 9.66 months (95% CI, 6.20-13.12 months) and 15.89 months (95% CI, 13.89-17.78), respectively. Treatment was generally well tolerated, and there were no Treatment emergent adverse events (TEAEs) with a toxicity grade equal to or exceeding 3 or that led to termination of treatment or patient death.Over the treatment interval of bevacizumab therapy from week 3 to week 10, patients with a large decrease of SUVmean was associated with a better PFS with a hazard ratio (HR) of 6.562, 95% CI (1.318-32.667), p=0.022. According to Kaplan-Meier analysis, patients with a decrease in the SUVmean of more than 0.115 on F-RGD PET/CT had a longer PFS than those with a decrease in the SUVmean of 0.115 or less (12.25 months vs.7.46 months, p=0.009). For OS, only a small decrease of Ktrans was also found to have certain prognostic value (HR=0.986, 95% CI (0.975-0.998), p=0.023). Patients with a decrease in Ktrans larger than 37.03 (min-1) on DCE-MRI had worse OS than those with a decrease in Ktrans of 37.03 (min-1) or less (15.93 months vs. 26.42 months, p=0.044).
F-RGD PET/CT and DCE-MRI may be valuable in evaluating the response of glioblastoma to treatment with the combination of bevacizumab and CCRT, with a greater decrease in SUV predicting better PFS as well as a small decrease in K predicting improved OS.
探讨基于F-AlF-NOTA-PRGD2正电子发射断层扫描/计算机断层扫描（F-RGD PET/CT）和动态对比增强磁共振成像（DCE-MRI）成像的潜在影像生物标志物预测贝伐单抗联合传统疗法治疗术后新诊断胶质母细胞瘤疗效的能力。
前瞻性纳入20例术后新诊断胶质母细胞瘤患者，接受贝伐单抗联合传统同步放化疗及替莫唑胺（CCRT）治疗。对每位患者在基线、第3周和第10周进行F-RGD PET/CT和DCE-MRI检查。统计方法包括方差分析（ANOVA）、Kaplan-Meier法和Cox比例风险分析。
所有患者均顺利完成CCRT加贝伐单抗治疗，无中断。中位随访时间为33.9个月（95%置信区间[CI]，28.3 - 39.5个月）。中位无进展生存期（PFS）和总生存期（OS）分别为9.66个月（95% CI，6.20 - 13.12个月）和15.89个月（95% CI，13.89 - 17.78个月）。治疗耐受性总体良好，未出现毒性等级等于或超过3级、导致治疗终止或患者死亡的治疗期间出现的不良事件（TEAE）。在贝伐单抗治疗第3周 至第10周的治疗期间，SUVmean大幅下降的患者PFS较好，风险比（HR）为6.562，95% CI（1.318 - 32.667），p = 0.022。根据Kaplan-Meier分析，F-RGD PET/CT上SUVmean下降超过0.115的患者PFS长于SUVmean下降0.115或更低的患者（12.25个月对7.46个月，p = 0.009）。对于OS，仅发现Ktrans小幅下降也具有一定的预后价值（HR = 0.986，95% CI（0.975 - 0.998），p = 0.023）。DCE-MRI上Ktrans下降大于37.03（min-1）的患者OS比Ktrans下降37.03（min-1）或更低的患者差（15.93个月对26.42个月，p = 0.044）。
F-RGD PET/CT和DCE-MRI在评估胶质母细胞瘤对贝伐单抗联合CCRT治疗的反应方面可能具有价值，SUV下降越大预测PFS越好，K小幅下降预测OS改善。
