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Prognostic Significance of Interim 11C-Methionine PET/CT in Primary Central Nervous System Lymphoma

Ahn, Seo-Yeon, MD*; Kwon, Seong Young, MD; Jung, Sung-Hoon, MD*; Ahn, Jae-Sook, MD*; Yoo, Su Woong, MD; Min, Jung-Joon, MD; Bom, Hee-Seung, MD; Ki, So Yeon, MD; Kim, Hyeoung-Joon, MD*; Lee, Je-Jung, MD*; Song, Sang Yun, MD§; Yang, Deok-Hwan, MD*

doi: 10.1097/RLU.0000000000002154
Original Articles

Purpose Primary central nervous system lymphoma (PCNSL) has a poor prognosis. There has been limited study evaluating the role of interim PET/CT in PCNSL. This prospective study investigated the interim response using sequential brain PET/CT with 11C-methionine (11C-MET) to provide prognostic information during the treatment of PCNSL.

Materials and Methods A total of 26 immunocompetent patients recently diagnosed with PCNSL were evaluated. Brain MRI and 11C-MET PET/CT were performed at the time of diagnosis and after 4 cycles of high-dose methotrexate-based induction chemotherapy. Tumor-to-normal tissue (T/N) ratio and MTV were used to assess the interim response.

Results All patients had diffuse large B-cell lymphoma. No differences were observed in initial tumor volume or quantitative uptake among the International Extranodal Lymphoma Study Group groups. Higher International Extranodal Lymphoma Study Group risk scores were associated with higher median values for interim MTV and T/N ratios, as well as poor outcomes. After a median follow-up of 21 months, interim 11C-MET PET/CT assessments based on the quantitative T/N ratio and MTV predicted progression-free survival and overall survival, respectively. A high interim T/N ratio was significantly associated with decreased progression-free survival (hazards ratio, 3.68; P = 0.044).

Conclusions Response assessments based on interim 11C-MET PET/CT could predict the therapeutic outcome of PCNSL.

From the Departments of *Hematology-Oncology,

Nuclear Medicine,

Radiology, and

§Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea.

Received for publication March 3, 2018; revision accepted April 23, 2018.

Seo-Yeon Ahn and Seong Young Kwon contributed equally to this work.

Conflicts of interest and sources of funding: This study was supported by a grant (HCRI 14 030–21) Chonnam National University Hwasun Hospital Institute for Biomedical Science. None declared to all authors.

Correspondence to: Sang Yun Song, MD, Department of Thoracic, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanam-do 519–763, Republic of Korea. E-mail:; or Deok-Hwan Yang, MD, Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanam-do 519–763, Republic of Korea. E-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.