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Response assessment of bevacizumab therapy in GBM with integrated 11C-MET-PET/MRI: a feasibility study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to evaluate the potential of integrated 11C-MET PET/MR for response assessment of relapsed glioblastoma (GBM) receiving bevacizumab treatment.

Methods

Eleven consecutive patients with relapsed GBM were enrolled for an integrated 11C-MET PET/MRI at baseline and at follow-up. Treatment response for MRI was evaluated according to Response Assessment in Neuro-oncology (RANO) criteria and integrated 11C-MET PET was assessed by the T/N ratio.

Results

MRI showed no patient with complete response (CR), six of 11 patients with PR, four of 11 patients with SD, and one of 11 patients with progressive disease (PD). PET revealed metabolic response in five of the six patients with partial response (PR) and in two of the four patients with stable disease (SD), whereas metabolic non-response was detected in one of the six patients with PR, in two of the four patients with SD, and in the one patient with PD. Morphological imaging was predictive for PFS and OS when response was defined as CR, PR, SD, and non-response as PD. Metabolic imaging was predictive when using T/N ratio reduction of >25 as discriminator. Based on the morphologic and metabolic findings of this study a proposal for applying integrated PET/MRI for treatment response in relapsed GBM was developed, which was significantly predictive for PFS and OS (P = 0.010 respectively 0,029, log).

Conclusions

This study demonstrates the potential of integrated 11C-MET-PET/MRI for response assessment of GBM and the utility of combined assessment of morphologic and metabolic information with the proposal for assessing relapsed GBM.

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Abbreviations

PET:

Positron emission tomography

MRI:

Magnetic resonance imaging

11C-MET:

L-[methyl-11C] Methionine

SUVmax:

Standardized uptake value of the tumor showing the maximum uptake

MTV:

Metabolic tumor volume

PFS:

Progression-free survival

OS:

Overall survival

c1:

Follow-up

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Author notes

    Authors and Affiliations

    1. Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, D-45122, Essen, Germany

      Cornelius Deuschl, Christoph Moenninghoff, Sophia Goericke, Michael Forsting, Lale Umutlu & Marc Schlamann

    2. Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Duisburg, Germany

      Cornelius Deuschl & Harald H. Quick

    3. Institute of Diagnostic and Interventional Radiology, University Hospital Duesseldorf, Duesseldorf, Germany

      Julian Kirchner

    4. Department of Neurology, University Hospital Essen, Essen, Germany

      Susanne Köppen

    5. Department of Nuclear Medicine, University Hospital Essen, Essen, Germany

      Ina Binse, Thorsten D. Poeppel & Ken Herrmann

    6. High Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany

      Harald H. Quick

    7. Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany

      Joerg Hense

    8. Department of Neuroradiology, University Hospital Giessen, Essen, Germany

      Marc Schlamann

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    1. Cornelius Deuschl
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    Correspondence to Cornelius Deuschl.

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    Funding

    An IFORES grant to CD from the University Duisburg-Essen supported the research [http://www.uni-due.de/med/forschung/forschungsfoerderung/ifores.shtml]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    Conflict of interest

    Nothing to disclosure.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Commission of the Medical Faculty of the University Duisburg-Essen and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study is registered at the Ethics Commission of the Medical Faculty of the University Duisburg-Essen with the number 11–4822-BO. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

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    Joerg Hense and Marc Schlamann contributed equally to this work.

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    Deuschl, C., Moenninghoff, C., Goericke, S. et al. Response assessment of bevacizumab therapy in GBM with integrated 11C-MET-PET/MRI: a feasibility study. Eur J Nucl Med Mol Imaging 44, 1285–1295 (2017). https://doi.org/10.1007/s00259-017-3661-0

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