Identification of time-to-peak on dynamic 18F-FET-PET as a prognostic marker specifically in IDH1/2 mutant diffuse astrocytoma

Bogdana Suchorska; Armin Giese; Annamaria Biczok; Marcus Unterrainer; Michael Weller; Mark Drexler; Peter Bartenstein; Ulrich Schüller; Jörg-Christian Tonn; Nathalie L Albert

doi:10.1093/neuonc/nox153

Identification of time-to-peak on dynamic 18F-FET-PET as a prognostic marker specifically in IDH1/2 mutant diffuse astrocytoma

Neuro Oncol. 2018 Jan 22;20(2):279-288. doi: 10.1093/neuonc/nox153.

Affiliation

¹ Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany (B.S., A.B., J.C.T.); German Cancer Consortium, partner site Munich, German Cancer Research Center, Heidelberg, Germany (B.S., A.G., A.B., M.U., M.D., P.B., U.S., J.C.T., N.L.A.); Department of Neuropathology (A.G., U.S.) and Department of Nuclear Medicine (M.U., M.D., P.B., N.L.A.), Ludwig-Maximilians-University, Munich, Germany; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland (M.W.).

Abstract

Background: Stratification of glioma according to isocitrate dehydrogenase 1/2 (IDH1/2) mutation and 1p/19q codeletion status has gained major importance in the new World Health Organization (WHO) classification. Parameters derived from uptake dynamics of 18F-fluoro-ethyl-tyrosine PET (18F-FET-PET) such as minimal time-to-peak (TTPmin) allow discrimination between different prognostic glioma subgroups, too. The present study is aimed at exploring whether TTPmin analysis provides prognostic information beyond the WHO classification.

Methods: Three hundred patients with newly diagnosed WHO 2007 grades II-IV gliomas with 18F-FET-PET imaging at diagnosis were grouped into 4 subgroups (IDH1/2 mut-1p/19q codel; IDH1/2 mut-1p/19q non-codel; IDH1/2 wildtype WHO grade II and III tumors; and glioblastoma). Clinical and imaging factors such as age, Karnofsky performance score, treatment, TTPmin, and maximal tumor-to-brain ratio (TBRmax) were analyzed with regard to progression-free and overall survival (PFS and OS) via univariate and multivariate regression analysis.

Results: PFS and OS were longest in the IDH1/2 mut-1p/19q codel subgroup, followed by IDH1/2 mut-1p/19q non-codel, IDH1/2 wildtype, and GBM (P < 0.001). Further, outcome stratified by TTPmin with a cutoff of 17.5 minutes revealed significantly longer PFS and OS in patients with TTPmin >17.5 minutes (P < 0.001 for PFS and OS). Lower TBRmax values or the absence of 18F-FET uptake was also associated with favorable outcome in the entire group. In the subgroup analyses, longer median TTPmin was associated with improved outcome specifically in the IDH1/2 mut-1p/19q non-codel group.

Conclusion: 18F-FET-PET-derived dynamic analysis defines prognostically distinct subgroups of IDH1/2 mutant-1p/19q non-codel gliomas which cannot be distinguished as yet by molecular marker analysis.

Keywords: 18F-FET-PET; 1p/19q co-deletion; IDH1/2 mutation; glioma; kinetic analysis; prognostic value.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Astrocytoma / diagnosis
Astrocytoma / genetics*
Brain Neoplasms / diagnosis
Brain Neoplasms / genetics
Child
Chromosomes, Human, Pair 19 / genetics
Female
Humans
Isocitrate Dehydrogenase / genetics*
Male
Middle Aged
Mutation / genetics*
Positron-Emission Tomography / methods
Prognosis
Time Factors
Tyrosine / analogs & derivatives*
Young Adult

Substances

(18F)fluoroethyltyrosine
Tyrosine
IDH2 protein, human
Isocitrate Dehydrogenase
IDH1 protein, human