title: Prognostic value of 3'-deoxy-3'-18F-fluorothymidine ([(18)F] FLT PET) in patients with recurrent malignant gliomas.
abstract: BACKGROUND
  3'-deoxy-3'-18F-fluorothymidine ([(18)F] FLT) PET has been proven to be of value in diagnosis and assessment of glioma grading, in differentiating tumor recurrence from necrosis, in response assessment and in predicting overall survival (OS) in the primary high grade glioma. In this study, we evaluated the value of [(18)F] FLT PET-CT in predicting the OS of patients with recurrent malignant glioma.
  
  
  METHODS
  Fifty-six patients with recurrent malignant glioma were enrolled in this prospective study. The PET-CT and contrast-enhanced MRI scans were performed in all patients. Tumor volume was determined from both PET image (proliferative volume, PV) and MRI image (Vol-MRI). Patients were followed up clinically until death. The likelihood of using PET-derived parameters of SUVmax, tumor-to-normal (T/N) ratio, and PV to predict the OS of patients were assessed in comparison with Vol-MRI and other clinical parameters.
  
  
  RESULTS
  The follow up periods for all patients ranged from 1.5 to 35.6 months with median of 9.8 months. Univariate analysis showed that the following parameters were significantly correlated with OS: grade of primary tumor (p=0.042), Karnofsky performance score (KPS) (p=0.041), T/N ratio (p<0.01), Vol-MRI (p=0.041), and PV (p<0.001). However, multivariate Cox regression showed that only the PV (p<0.001) and T/N ratio (p=0.001) were independent predictors. The thresholds to predict OS were 16.88 cm(3) for PV and 10.94 for T/N ratio. Kaplan-Meier analyses using these thresholds showed a significant discrimination between short and long OS groups (p<0.001).
  
  
  CONCLUSIONS
  The PV and T/N ratio of tumor on [(18)F] FLT PET-CT are independent predictors of survival in patients with recurrent malignant glioma. The PV on [(18)F] FLT PET seems to be more predictive than tumor volume on T1-weighted MRI for OS.
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Fen
authors.initials: F
authors.lastname: Zhao
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Minghuan
authors.initials: M
authors.lastname: Li
authors.affiliation: Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China; Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Fu
authors.affiliation: Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China; Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Zhaoqiu
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Li
authors.initials: L
authors.lastname: Kong
authors.affiliation: Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China; Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
authors.forename: Guoren
authors.initials: G
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China; Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital and Institute, Jinan, Shandong, China. Electronic address: sdyujinming@126.com.
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D015224:Dideoxynucleosides; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis
chemical_list: D015224:Dideoxynucleosides; C002854:alovudine
keywords: MRI; Malignant glioma; Recurrence; Survival prediction; [(18)F] FLT PET