2-[18F]fluoro-2-deoxyglucose and glucose uptake in malignant gliomas before and after radiotherapy: Correlation with outcome

Alexander M. Spence, Mark Muzi, Michael M. Graham, Finbarr O'Sullivan, Jeanne M. Link, Thomas K. Lewellen, Barbara Lewellen, Scott D. Freeman, David A. Mankoff, Janet F. Eary, Kenneth A. Krohn

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47 Scopus citations

Abstract

Purpose: To examine whether quantitative 1-[11C]glucose- or 2-[18F]fluoro-2-deoxyglucose (FDG)-positron emission tomography performed before and/or after radiotherapy (RT) of malignant gliomas correlates with treatment outcome. Changes in metabolism between the start and finish of RT, and immediate post-RT studies have received little attention. Experimental Design: Adults with malignant gliomas were imaged within 2 weeks before and/or 2 weeks after RT. Four patients were imaged only before RT, 12 only after RT, and 14 both before and after RT. Each 1-[11C]glucose and FDG study included arterial plasma sampling. Kinetic parameters, glucose metabolic rate (MRGlc), and FDG metabolic rate (MRFDG) were estimated by an optimization program based on a three compartment, four rate constant model. Changes in MRGlc or MRFDG from pre-RT to post-RT were calculated for the 14 patients studied at both times. Overall survival was examined, and survival was computed relative to historical controls in matched prognostic classes. Results: Low pre-RT MRGlc (P < 0.02) or MRFDG (P < 0.03), or an increase from pre- to post-RT in MRGlc (P < 0.004) or MRFDG (P < 0.006) are correlating with longer survival (4 patients still alive). Strikingly, the post-RT studies (n = 26) showed no correlation between MRGlc or MRFDG and survival (P = 0.73 and P = 0.46 respectively). Conclusions: Low MRGlc or MRFDG before RT probably indicates less aggressive disease. An increase in MRGlc or MRFDG from pre- to post-RT in the tumors of patients with longer survival could be because of one or more of the following or other reasons: (a) apoptosis of tumor cells in response to RT requires energy; (b) decreased tumor cell density by the RT leaving normal cells with higher metabolism; or (c) inflammatory cells infiltrate and take up glucose or FDG where tumor cells are dying. Quantitative 1-[11C]glucose or FDG uptake in the early weeks post-RT correlates poorly with survival.

Original languageEnglish (US)
Pages (from-to)971-979
Number of pages9
JournalClinical Cancer Research
Volume8
Issue number4
StatePublished - Apr 1 2002

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Spence, A. M., Muzi, M., Graham, M. M., O'Sullivan, F., Link, J. M., Lewellen, T. K., Lewellen, B., Freeman, S. D., Mankoff, D. A., Eary, J. F., & Krohn, K. A. (2002). 2-[18F]fluoro-2-deoxyglucose and glucose uptake in malignant gliomas before and after radiotherapy: Correlation with outcome. Clinical Cancer Research, 8(4), 971-979.