The Impact of FDG PET on the Management of Patients with Glioma after Initial Therapy: A Prospective, Multi-Centre Study as Part of the Australian PET Data Collection Project
Objectives: To: a) assess the impact of FDG PET on the management of patients with a residual cerebral lesion after prior treatment for glioma and, b) determine the incremental information provided by FDG PET in this context.
Methods: Eighty two patients (54M, 28F, median age 48 yrs) with prior treatment for glioma, a cerebral lesion on anatomical imaging and who were considered for further therapy underwent PET scans across 3 centres. Pre-PET management plans were documented blinded to PET results; management plan changes due to the PET findings were documented. Follow-up to 12 months post-treatment was performed to determine actual management and clinical outcome.
Results: All 82 patients were eligible for analysis. Grade of original tumor was: I (5), II (22), III (28) and IV (27). PET/CT was done in 56 (68.3%) and PET alone in 26 (31.7%) patients. PET changed management in 37 (45.1%) patients (95% CI 33.8% - 55.87%). Impact on management was high in 35 (42.7%) patients and medium in 2 (2.4%). Patients with regions of increased FDG uptake were more likely to progress within 12 months (χ2 = 17.71, p< 0.0001). In addition, when compared with MR, PET was more accurate at identifying patients who were less likely to develop disease progression by 12 months (p = 0.000043).
Conclusions: This study clearly shows that FDG PET has an important impact on the management of patients with suspected recurrent glioma and identifies those patients who are more likely to develop progressive disease.