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Use of 11C-methionine PET to monitor the effects of temozolomide chemotherapy in malignant gliomas.
Galldiks N, Kracht L, Burghaus L, Thomas A, Jacobs A, Heiss W, Herholz KG
Eur J Nucl Med Mol Imaging. 2006;33( 5):516-24.
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Abstract
PURPOSE: The purpose of this study was to monitor the metabolic effects of temozolomide (TMZ) chemotherapy in malignant gliomas by means of repeated positron emission tomography (PET) with [(11)C]methionine (MET). METHODS: Fifteen patients with histologically proven malignant glioma were treated by TMZ chemotherapy. MET-PET studies were performed before and after the third cycle of TMZ chemotherapy in all patients, and in 12 patients also after the sixth cycle. Gadolinium-enhanced MRI studies were performed in 12 patients before the first and after the sixth cycle. Clinical status was assessed by the modified Rankin scale. Long-term outcome was assessed by calculating the time to progression (TTP) in months. RESULTS: Decline in MET uptake during therapy corresponded to a stable clinical status. The median TTP was significantly longer in patients with decline in MET uptake than in those with increasing MET uptake (23 vs 3.5 months; p=0.01, log rank test). There was no significant correlation between change in MET uptake and change in contrast enhancement during treatment for all patients. CONCLUSION: The present data demonstrate that clinical stability, which is often achieved under TMZ chemotherapy of malignant glioma, corresponds to a decline in or stability of tumour amino acid metabolism. Tumour responses can already be demonstrated with MET-PET after three cycles of chemotherapy, and absence of progression at that time indicates a high probability of further stability during the next three cycles. A reduction in MET uptake during TMZ treatment predicts a favourable clinical outcome. Molecular imaging of amino acid uptake by MET-PET offers a new method of measurement of the biological activity of recurrent glioma.
Keyword(s)
Adult; Aged; Female; Humans; Male; Middle Aged; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; analogs & derivatives: Dacarbazine; diagnostic use: Methionine; diagnostic use: Radiopharmaceuticals; drug therapy: Glioma; methods: Positron-Emission Tomography; therapeutic use: Antineoplastic Agents, Alkylating