Monday, December 19, 2011

Independent prognostic value of pre-treatment 18-FDG-PET in high-grade gliomas

Abstract  
The prognostic value of PET with (18F)-fluoro-2-deoxy-d-glucose (FDG) has been shown in high-grade gliomas (HGG), but not compared with consensual prognostic factors. We sought to evaluate the independent predictive value of pre-treatment FDG-PET on overall (OS) and event-free survival (EFS). We retrospectively analyzed 41 patients with histologically-confirmed HGG (31 glioblastomas and 10 anaplastic gliomas). The pre-treatment uptake of FDG was assessed qualitatively by five-step visual metabolic grading, and quantitatively by the ratio between the tumor and contralateral maximal standardized uptake value (T/CL). EFS and OS following PET were compared with FDG uptake by univariate analysis, and by two multivariate analyses: one including main consensual prognostic factors (age, KPS, extent of surgery and histological grade), and the other including the classification system of the Radiation Therapy Oncology Group (Recursive Partitioning Analysis, RPA). Median OS and EFS were 13.8 and 7.4 months, respectively, for glioblastomas, and over 25.8 and 12 months, respectively, for anaplastic gliomas (P = 0.040 and P = 0.027). The T/CL ratio predicted OS in the entire group [P = 0.003; Hazard Ratio (HR) = 2.3] and in the glioblastoma subgroup (P = 0.018; HR = 2), independently of age, Karnofsky performance status, histological grade, and surgery, and independently of RPA classification. T/CL ratio tended to predict EFS in the whole group (P = 0.052). The prognostic value of visual metabolic grade on OS was less significant than T/CL ratio, both in the entire group and in the glioblastoma subgroup (P = 0.077 and P = 0.059). Quantitative evaluation of the ratio between the maximal tumor and contralateral uptake in pre-treatment FDG-PET provides significant additional prognostic information in newly-diagnosed HGG, independently of consensual prognostic factors.

  • Content Type Journal Article
  • Category Clinical Study - Patient Study
  • Pages 1-9
  • DOI 10.1007/s11060-011-0771-6
  • Authors
    • Cécile Colavolpe, APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France
    • Philippe Metellus, APHM, Hôpital de la Timone, Service de Neurochirurgie, 13005 Marseille, France
    • Julien Mancini, APHM, Hôpital de la Timone, Service de Santé Publique et d'Information Médicale, 13005 Marseille, France
    • Maryline Barrie, APHM, Hôpital de la Timone, Unité de Neuro-Oncologie, 13005 Marseille, France
    • Céline Béquet-Boucard, APHM, Hôpital de la Timone, Unité de Neuro-Oncologie, 13005 Marseille, France
    • Dominique Figarella-Branger, Aix-Marseille Université, UMR 911 Inserm, 13005 Marseille, France
    • Olivier Mundler, APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France
    • Olivier Chinot, Aix-Marseille Université, UMR 911 Inserm, 13005 Marseille, France
    • Eric Guedj, APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France





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