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The goal of this study was to compare the value of contrast-enhanced MRI and O-(2-[ 18 F]fluoroethyl)-l-tyrosine ( 18 F-FET) PET for response assessment in glioma patients after adjuvant temozolomide chemotherapy (TMZ). Methods: After biopsy or resection and completion of radiotherapy with concomitant TMZ, 41 newly diagnosed and histomolecularly characterized glioma patients (glioblastoma, 90%; age range, 20-79 y) were subsequently treated with adjuvant TMZ. MR and 18 F-FET PET imaging were performed at baseline and after the second cycle of adjuvant TMZ. We obtained 18 F-FET metabolic tumor volumes (MTVs) as well as mean and maximum tumor-to-brain ratios (TBR mean and TBR max , respectively). Threshold values of 18 F-FET PET parameters to predict outcome were established by receiver-operating-characteristic analyses using a median progression-free survival (PFS) of ≥ 9 mo and overall survival (OS) of ≥ 15 mo as reference. MRI response assessment was based on the Response Assessment in Neuro-Oncology (RANO) working group criteria. The predictive value of changes of 18 F-FET PET and MRI parameters on survival was evaluated subsequently using univariate and multivariate survival estimates. Results: After 2 cycles of adjuvant TMZ chemotherapy, a treatment-induced reduction of MTV and TBR max predicted a significantly longer PFS and OS (both P ≤ 0.03; univariate survival analyses) whereas RANO criteria were not significant ( P &gt; 0.05). Multivariate survival analysis revealed that TBR max changes predicted a prolonged PFS ( P = 0.012) and changes of MTV a prolonged OS ( P = 0.005) independent of O 6 -methylguanine-DNA-methyltransferase promoter methylation and other strong prognostic factors. Conclusion: Changes of 18 F-FET PET parameters appear to be helpful for identifying responders to adjuvant TMZ early after treatment initiation.

the journal of nuclear medicine

Early treatment response assessment using <sup>18</sup>F-FET PET compared to contrast-enhanced MRI in glioma patients following adjuvant temozolomide chemotherapy

Early treatment response assessment using 18F-FET PET compared to contrast-enhanced MRI in glioma patients following adjuvant temozolomide chemotherapy

Early treatment response assessment using ¹⁸F-FET PET compared to contrast-enhanced MRI in glioma patients following adjuvant temozolomide chemotherapy