Spatial and quantitative mapping of glycolysis and hypoxia in glioblastoma as a predictor of radiotherapy response and sites of relapse.

Abstract

INTRODUCTION:

Tumor hypoxia is a centerpiece of disease progression mechanisms such as neoangiogenesis or aggressive hypoxia-resistant malignant cells selection that impacts on radiotherapy strategies. Early identification of regions at risk for recurrence and prognostic-based classification of patients is a necessity to devise tailored therapeutic strategies. We developed an image-based algorithm to spatially map areas of aerobic and anaerobic glycolysis (Glyoxia).

METHODS:

18F-FDG and 18F-FMISO PET studies were used in the algorithm to produce DICOM-co-registered representations and maximum intensity projections combined with quantitative analysis of hypoxic volume (HV), hypoxic glycolytic volume (HGV), and anaerobic glycolytic volume (AGV) with CT/MRI co-registration. This was applied to a prospective clinical trial of 10 glioblastoma patients with post-operative, pre-radiotherapy, and early post-radiotherapy 18F-FDG and 18F-FMISO PET and MRI studies.

RESULTS:

In the 10 glioblastoma patients (5M:5F; age range 51-69 years), 14/18 18F-FMISO PET studies showed detectable hypoxia. Seven patients survived to complete post-radiotherapy studies. The patient with the longest overall survival showed non-detectable hypoxia in both pre-radiotherapy and post-radiotherapy 18F-FMISO PET. The three patients with increased HV, HGV, and AGV volumes after radiotherapy showed 2.8 months mean progression-free interval vs. 5.9 months for the other 4 patients. These parameters correlated at that time point with progression-free interval. Parameters combining hypoxia and glycolytic information (i.e., HGV and AGV) showed more prominent variation than hypoxia-based information alone (HV). Glyoxia-generated images were consistent with disease relapse topology; in particular, one patient had distant relapse anticipated by HV, HGV, and AGV maps.

CONCLUSION:

Spatial mapping of aerobic and anaerobic glycolysis allows unique information on tumor metabolism and hypoxia to be evaluated with PET, providing a greater understanding of tumor biology and potential response to therapy.

• Authors: Antoine Leimgruber, Kevin Hickson, Sze Ting Lee, Hui K Gan, Lawrence M Cher, John I Sachinidis, Graeme J O'Keefe, Andrew M Scott
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 47 Issue 6 Pg. 1476-1485 (06 2020) ISSN: 1619-7089 [Electronic] Germany
• PMID: 32025750 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Radiopharmaceuticals
• Fluorodeoxyglucose F18
• Misonidazole

Topics

• Aged
• Fluorodeoxyglucose F18
• Glioblastoma (diagnostic imaging, radiotherapy)
• Glycolysis
• Humans
• Hypoxia (diagnostic imaging)
• Middle Aged
• Misonidazole
• Neoplasm Recurrence, Local (diagnostic imaging, radiotherapy)
• Positron-Emission Tomography
• Prospective Studies
• Radiopharmaceuticals