18F–Fluoromisonidazole (FMISO) and 18F–fluorodeoxyglucose (FDG) PET in patients undergoing radiotherapy or chemotherapy following surgery for high-grade glioma

  • Dr Sze Ting Lee, Centre for PET; Department of Medicine; Ludwig Institute for Cancer Research, Austin Hospital, Victoria, Australia
  • Dr Swaroop Valluri, Centre for PET, Austin Hospital, Victoria, Australia
  • Dr Bobby Sundralingam, Centre for PET, Austin Hospital, Victoria, Australia
  • Dr Salvatore Berlangieri, Centre for PET, Austin Hospital, Victoria, Australia
  • Dr Graeme O'Keefe, Centre for PET, Austin Hospital, Victoria, Australia
  • Dr John Sachinidis, Centre for PET, Austin Hospital, Victoria, Australia
  • Ms Kunthi Pathmaraj, Centre for PET, Austin Hospital, Victoria, Australia
  • Mr Gavin Fabinyi, Department of Neurosurgery, Austin Hospital, Victoria, Australia
  • Dr Morikatsu Wada, Department of Radiation Oncology, Austin Hospital, Australia
  • Dr Lawrence Cher, Ludwig Oncology Unit, Austin Hospital, Australia
  • Dr Andrew Scott, Austin Health, Ludwig Institute for Cancer Research, University of Melbourne, Australia

    • Background: Tumour hypoxia is associated with disease progression and resistance to therapy. High grade cerebral gliomas have a poor outcome despite advancements in chemotherapy and radiotherapy. 18F–fluoromisonidazole (18F-FMISO) concentrates in hypoxic cells and is associated with tumour grade in gliomas. The aim of this study was to compare the patterns of uptake of 18F-FDG PET and 18F-FMISO PET post-surgery with MRI and areas of recurrence post-radiotherapy.

    Methods: Patients with high grade cerebral glioma were recruited into this prospective study. All patients had post-surgical, pre-radiotherapy 18F-FDG, 18F-FMISO and MRI scans, which were all repeated 4-6 weeks post-completion of radiotherapy. The patients were followed-up clinically three monthly and re-imaged if indicated.

    Results: Ten patients were enrolled in this study, mean age 62 years (range 55-69 years), who all had pre-radiotherapy scans performed. Seven patients had scans done pre- and post-radiotherapy, with 3 patients with only pre-therapy scans. Nine patients had significant FMISO uptake and 8 patients demonstrated abnormal FDG uptake. The areas of FMISO uptake on pre-radiotherapy scans correlated with the most abnormal areas of contrast-enhancement on pre-treatment MRI and areas of locally recurrent disease on post-treatment MRI in eight patients. Nine patients had locally recurrent disease on follow-up MRI. FMISO was more predictive of tumour recurrence compared to FDG.

    Conclusion: Post-surgical 18F-FMISO PET in patients with cerebral glioma is more predictive of areas of recurrent disease compared to 18F-FDG PET.