This study examined the value of a novel 1-step labeled integrin α v β 3 -targeting 18 F-AlF-NOTA-PRGD2 (denoted as 18 F-RGD) scan in assessing sensitivity to concurrent chemoradiotherapy (CCRT) in patients with newly diagnosed glioblastoma multiforme (GBM). Methods: Twenty-five patients with newly diagnosed GBM were enrolled in this study 3-5 wk after surgical resection. All participants were investigated with 18 F-RGD PET/CT on baseline (T1) and at the third week (T2) after the start of CCRT. Tumor volume, maximal and mean standardized uptake value of the tumor (SUV max , SUV mean ), and tumor-to-nontumor ratios of the tumor volume were obtained. The MRI treatment response was assessed at the 11th week (T3). The change in the lesion volume from T1 to T3 on MRI was used as an endpoint to evaluate the predictive ability of 18 F-RGD PET/CT. Results: With 18 F-RGD PET/CT imaging, we successfully visualized the residual lesions of GBM. Twenty-five and 23 18 F-RGD PET/CT scans at baseline and the third week, respectively, were available for analysis. We found that 18 F-RGD PET/CT parameters, both pretreatment SUV max on baseline (P , 0.05) and intratreatment SUV max at the third week (SUV maxT2 ) (P , 0.05) and tumor-to-nontumor ratios at the third week (P , 0.05), were predictive of treatment sensitivity to CCRT. Additionally, the change of volume from T1 to T2 on MRI was also predictive (P , 0.05). According to receiver-operating-characteristic curve analysis, the most significant parameter was SUV maxT2 (area under the curve, 0.846). The threshold of SUV maxT2 was 1.35, and its sensitivity, specificity, and accuracy were 84.6%, 90.0% and 87.0%, respectively. Conclusion: 18 F-RGD PET/CT allows for the noninvasive visualization of GBM lesions and the prediction of sensitivity to CCRT as early as 3 wk after treatment initiation.
Radiotherapy, particularly the target delineation of cancer based on scanned images, plays a key role in the planning of cancer treatment. Recently, diffusion-weighted magnetic resonance imaging (DW-MRI) has emerged as a prospective superior procedure compared with intensified computed tomography (CT) and positron emission tomography (PET) in the target delineation of cancer. However, the implication of DW-MRI in lung cancer, the leading cause of cancer-associated mortality worldwide, has not been extensively evaluated. In the present study, the gross target volumes of lung cancer masses delineated using the DW-MRI, CT and PET procedures were compared in a pairwise manner in a group of 27 lung cancer patients accompanied with atelectasis of various levels. The data showed that compared with CT and PET procedures, DW-MRI has a more precise delineation of lung cancer while exhibiting higher reproducibility. Together with the fact that it is non-invasive and cost-effective, these data demonstrate the great application potential of the DW-MRI procedure in cancer precision radiotherapy.
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