{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:01:51Z","timestamp":1789794111500,"version":"4.0.1"},"reference-count":42,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Institute of Health Carlos III","doi-asserted-by":"publisher","award":["CP23\/000106"],"award-info":[{"award-number":["CP23\/000106"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Institute of Health Carlos III","doi-asserted-by":"publisher","award":["AC23_1\/00012"],"award-info":[{"award-number":["AC23_1\/00012"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"award":["CP23\/000106"],"award-info":[{"award-number":["CP23\/000106"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"award":["AC23_1\/00012"],"award-info":[{"award-number":["AC23_1\/00012"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002704","name":"Fundaci\u00f3n Cient\u00edfica Asociaci\u00f3n Espa\u00f1ola Contra el C\u00e1ncer","doi-asserted-by":"publisher","award":["TRANSCAN2022-784-104"],"award-info":[{"award-number":["TRANSCAN2022-784-104"]}],"id":[{"id":"10.13039\/501100002704","id-type":"DOI","asserted-by":"publisher"}]},{"award":["TRANSCAN2022-784-104"],"award-info":[{"award-number":["TRANSCAN2022-784-104"]}],"id":[{"id":"https:\/\/ror.org\/00gxct719","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Glioblastoma (GBM) is a hard-to-treat cancer with a 5-year survival rate of 5.7% without significant improvement in the past decades. Personalised strategies based on improved tumour characterisation and treatment-outcome prediction could support treatment adaptation and improve therapeutic efficacy. Magnetic Resonance (MR) is the standard imaging modality for GBM radiotherapy (RT) planning. Positron Emission Tomography (PET) with O-(2)-[^18F]fluoroethyl-L-tyrosine (FET) is recommended for distinguishing recurrence from pseudo-progression. However, evidence on PET|MR complementarity for predicting treatment outcome in recurrent GBM remains limited. Methods: We evaluated FET-PET|MR biomarkers to predict Time-To-Progression (TTP), Overall Survival (OS) and Acute Recurrence (AR) in a prospective cohort of 185 recurrent GBM patients from 15 institutions. T1-weighted contrast-enhanced, Fluid-Attenuation Inversion-Recovery, Apparent-Diffusion-Coefficient maps and FET-PET images were analysed. Gross- and Planning-Target Volumes (GTV\/PTV) were manually delineated and the intersection of PET|MR-GTVs was defined as MR\u2229PET. Radiomics models were developed (5-fold cross-validation) and evaluated in a held-out test set. Additionally, nnUNet was used to predict MR\u2229PET from MR sequences. Results: MR\u2229PET volume yielded the highest number of statistically significant models, 15 versus 6 for PET|MR-GTVs and 0 for PET|MR-PTVs. Of these 21 models, 19 required the inclusion of PET imaging. The best-performing models discriminated between short and long OS, with p &lt; 0.0001 in validation and test, and predicted AR, with ROC-AUC(validation) = 0.81 and AUC(test) = 0.63. By combining both models, poor responders (short OS and\/or AR) were identified with Sensitivity = 82% and Specificity = 75%. MR-based prediction of MR\u2229PET showed a Dice Similarity Coefficient (test) = 0.87 \u00b1 0.12. Conclusions: The PET|MR radiomic models derived from our multicentre prospective cohort support the identification of recurrent GBM patients with poor RT outcomes, potentially enabling future personalised strategies for treatment improvement.<\/jats:p>","DOI":"10.3390\/cancers18183008","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:07:29Z","timestamp":1789574849000},"page":"3008","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["PET|MR Open Source Radiomics Models for Treatment Outcome Prediction in Recurrent GBM"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2401-8240","authenticated-orcid":false,"given":"Montserrat","family":"Carles","sequence":"first","affiliation":[{"name":"Biomedical Imaging Research Group (GIBI230), Health Research Institute La Fe, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Mora-Rubio","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Research Group (GIBI230), Health Research Institute La Fe, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6271-9385","authenticated-orcid":false,"given":"Tobias","family":"Fechter","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Division of Medical Physics, Faculty of Medicine, Medical Center\u2014University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Perez-Herrero","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Research Group (GIBI230), Health Research Institute La Fe, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mat\u00edas","family":"Fern\u00e1ndez-Pat\u00f3n","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Research Group (GIBI230), Health Research Institute La Fe, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4220-9083","authenticated-orcid":false,"given":"Dimos","family":"Baltas","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Division of Medical Physics, Faculty of Medicine, Medical Center\u2014University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9106-2519","authenticated-orcid":false,"given":"Michael","family":"Mix","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Faculty of Medicine, Medical Center\u2014University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Faculty of Medicine, Medical Center\u2014University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilinca","family":"Popp","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Faculty of Medicine, Medical Center\u2014University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Mart\u00ed-Bonmat\u00ed","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Research Group (GIBI230), Health Research Institute La Fe, 46026 Valencia, Spain"},{"name":"Department of Radiology, La Fe Polytechnic and University Hospital, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca L.","family":"Grosu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Faculty of Medicine, Medical Center\u2014University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"vi1","DOI":"10.1093\/neuonc\/noae145","article-title":"CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017\u20132021","volume":"26","author":"Price","year":"2024","journal-title":"Neuro-Oncology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109663","DOI":"10.1016\/j.radonc.2023.109663","article-title":"ESTRO-EANO guideline on target delineation and treatment of glioblastoma","volume":"184","author":"Niyazi","year":"2023","journal-title":"Radiother. 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