A New Fluorine-18-Fluoroethyltyrosine Positron-Emission-Tomography/Magnetic-Resonance-Based Tumor Resection Plan Improved the Prognosis of Glioblastoma Patients. A Multicenter Validated Study.

Abstract

Background: Glioblastoma, IDH-wild-type, is a highly invasive tumor, and prognosis largely depends on the extent of resection. Contrast-enhanced (CE) MRI often underestimates tumor borders, resulting in incomplete resection. Prospective multicenter evidence on positron emission tomography (PET)/magnetic resonance (MR)-guided resection planning in newly diagnosed glioblastoma remains limited. This study is the first nationwide, multicenter evaluation of 18F-fluoroethyltyrosine (FET) PET-guided glioma resection. Methods: We conducted a multicenter, prospective cohort study to evaluate the efficacy of a novel 18F-FET PET-based surgical planning system (PET/MR cross-modal tumor delineation system [PCMDS]) in glioblastoma, IDH-wild-type resection. The study comprised 239 patients: 115 underwent 18F-FET PET-guided surgery and 124 underwent CE MRI-guided surgery. The PCMDS integrated multimodal image registration and automated metabolic segmentation to delineate surgical margins. Resection outcomes were intraoperatively validated using ultrasound, MRI, and ultramicroscopic cellular imaging. Results: Compared with the CE MRI group, the 18F-FET PET group achieved a significantly higher gross total resection rate (91.3% versus 72.7%, P P = 0.0099; median progression-free survival: 12.5 versus 9.3 months, P = 0.0078). 18F-FET PET-defined margins extended beyond CE MRI-defined boundaries, and both histopathological analysis and single-cell RNA sequencing confirmed the presence of infiltrative tumor cells in 18F-FET PET-positive but MRI-negative regions. Conclusion: This multicenter study demonstrates that 18F-FET PET-based surgical planning significantly increases the extent of glioblastoma, IDH-wild-type resection and prolongs patient survival. Integrating 18F-FET PET into routine surgical practice could substantially improve clinical outcomes for patients with glioblastoma, IDH-wild-type.