Can a Novel 18F-ALF-NOTA-PRGD2 PET/CT Predict the Treatment Sensitivity of Concurrent Chemoradiotherapy in Patients with Newly Diagnosed Glioblastoma?

Purpose: This study examined the value of a novel one-step labeled integrin αvβ3-targeting¹⁸F-AlF-NOTA-PRGD2 (denoted as ¹⁸F-RGD) in assessing the sensitivity of concurrent chemoradiotherapy (CCRT) in patients with newly diagnostic glioblastoma multiforme (GBM). Methods: 25 patients with newly diagnosed GBM were enrolled in this study 3-5 weeks after surgical resection. All participants were investigated with ¹⁸F-RGD PET/CT on baseline (T1) and the third week (T2) after the start of CCRT. Tumor volume (TV), maximal and mean standard uptake of the tumor (SUV_max, SUVmean) and tumor to not-tumor ratios (T/NT) of the TV were obtained. The MRI treatment response was assessed at the 11th week (T3). The change in the lesion volume from T1 to T3 (VOLT1-3) on MRI was used as an endpoint to evaluate the predictive ability of ¹⁸F-RGD PET/CT. Results: With ¹⁸F-RGD PET/CT imaging, we successfully visualized the residual lesions of GBM. A total of 25 and 23 ¹⁸F-RGD PET/CT scans at baseline and the third week were available for analysis. We found that ¹⁸F-RGD PET/CT parameters, both pre-treatment SUV_maxT1 (P<0.05) and intra-treatment SUV_maxT2 (P<0.05) and T/NTT2 (P<0.05) were predictive of the treatment sensitivity of CCRT. Additionally, the change of volume from T1 to T2 (VOLT1-2) on MRI was also predictive (P<0.05). According to ROC curve analysis, the most significant parameter was SUV_maxT2 (AUC=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: ¹⁸F-RGD PET/CT allows for the noninvasive visualization of GBM lesions and the prediction of the sensitivity of CCRT as early as three weeks after treatment initiation.

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