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@ARTICLE{Werner:892345,
      author       = {Werner, Jan-Michael and Weller, Johannes and Ceccon, Garry
                      and Schaub, Christina and Tscherpel, Caroline and Lohmann,
                      Philipp and Bauer, Elena K. and Schäfer, Niklas and
                      Stoffels, Gabriele and Baues, Christian and Celik, Eren and
                      Marnitz, Simone and Kabbasch, Christoph and Gielen, Gerrit
                      H. and Fink, Gereon Rudolf and Langen, Karl-Josef and
                      Herrlinger, Ulrich and Galldiks, Norbert},
      title        = {{D}iagnosis of {P}seudoprogression {F}ollowing
                      {L}omustine–{T}emozolomide {C}hemoradiation in {N}ewly
                      {D}iagnosed {G}lioblastoma {P}atients {U}sing {FET}-{PET}},
      journal      = {Clinical cancer research},
      volume       = {27},
      number       = {13},
      issn         = {1078-0432},
      address      = {Philadelphia, Pa. [u.a.]},
      publisher    = {AACR},
      reportid     = {FZJ-2021-02013},
      pages        = {3704 - 3713},
      year         = {2021},
      abstract     = {Purpose: The CeTeG/NOA-09 phase III trial demonstrated a
                      significant survival benefit of lomustine–temozolomide
                      chemoradiation in patients with newly diagnosed glioblastoma
                      with methylated O6-methylguanine-DNA methyltransferase
                      (MGMT) promoter. Following lomustine–temozolomide
                      chemoradiation, late and prolonged pseudoprogression may
                      occur. We here evaluated the value of amino acid PET using
                      O-(2-[18F]fluoroethyl)-l-tyrosine (FET) for differentiating
                      pseudoprogression from tumor progression.Experimental
                      Design: We retrospectively identified patients (i) who were
                      treated off-study according to the CeTeG/NOA-09 protocol,
                      (ii) had equivocal MRI findings after radiotherapy, and
                      (iii) underwent additional FET-PET imaging for diagnostic
                      evaluation (number of scans, 1–3). Maximum and mean
                      tumor-to-brain ratios (TBRmax, TBRmean) and dynamic FET
                      uptake parameters (e.g., time-to-peak) were calculated. In
                      patients with more than one FET-PET scan, relative changes
                      of TBR values were evaluated, that is, an increase or
                      decrease of $>10\%$ compared with the reference scan was
                      considered as tumor progression or pseudoprogression.
                      Diagnostic performances were evaluated using ROC curve
                      analyses and Fisher exact test. Diagnoses were confirmed
                      histologically or clinicoradiologically.Results: We
                      identified 23 patients with 32 FET-PET scans. Within 5–25
                      weeks after radiotherapy (median time, 9 weeks),
                      pseudoprogression occurred in 11 patients $(48\%).$ The
                      parameter TBRmean calculated from the FET-PET performed 10
                      ± 7 days after the equivocal MRI showed the highest
                      accuracy $(87\%)$ to identify pseudoprogression (threshold,
                      <1.95; P = 0.029). The integration of relative changes of
                      TBRmean further improved the accuracy $(91\%;$ P < 0.001).
                      Moreover, the combination of static and dynamic parameters
                      increased the specificity to $100\%$ (P =
                      0.005).Conclusions: The data suggest that FET-PET parameters
                      are of significant clinical value to diagnose
                      pseudoprogression related to lomustine–temozolomide
                      chemoradiation.},
      cin          = {INM-3 / INM-4},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406 / I:(DE-Juel1)INM-4-20090406},
      pnm          = {5253 - Neuroimaging (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5253},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {33947699},
      UT           = {WOS:000670550600025},
      doi          = {10.1158/1078-0432.CCR-21-0471},
      url          = {https://juser.fz-juelich.de/record/892345},
}