Early change in glucose metabolic rate measured using FDG-PET in patients with high-grade glioma predicts response to temozolomide but not temozolomide plus radiotherapy

Purpose: To compare the ability of positron emission tomography (PET) to predict response to temozolomide vs. temozolomide plus radiotherapy. Methods and Materials: Nineteen patients with high-grade glioma (HGG) were studied. Patients with recurrent glioma received temozolomide 75 mg/m 2 daily for 7 weeks ( n = 8). Newly diagnosed patients received temozolomide 75 mg/m 2 daily plus radiotherapy 60 Gy/30 fractions over 6 weeks, followed by six cycles of adjuvant temozolomide 200 mg/m 2 /day (Days 1–5 q28) starting 1 month after radiotherapy ( n = 11). [ 18 F]Fluorodeoxyglucose ([ 18 F]FDG) PET scan and magnetic resonance imaging (MRI) were performed at baseline, and 7 and 19 weeks after initiation of temozolomide administration. Changes in glucose metabolic rate (MRGlu) and MRI response were correlated with patient survival. Results: In the temozolomide-alone group, patients who survived >26 vs. ≤26 weeks showed a greater reduction in MRGlu measured at 7 weeks with median changes of –34% and –4%, respectively ( p = 0.02). PET responders, defined as a reduction in MRGlu ≥25%, survived longer than nonresponders with mean survival times of 75 weeks (95% CI, 34–115 vs. 20 weeks (95% CI, 14–26) ( p = 0.0067). In the small group of patients studied, there was no relationship between MRI response and survival ( p = 0.52). For patients receiving temozolomide plus radiotherapy, there was no difference in survival between PET responders and nonresponders ( p = 0.32). Conclusions: Early changes in MRGlu predict response to temozolomide, but not temozolomide plus radiotherapy.