FET–PET for malignant glioma treatment planning

Niyazi, Maximilian; Geisler, Julia; Siefert, Axel; Schwarz, S.B.; Ganswindt, Ute; Garny, Sylvia; Schnell, Oliver; Suchorska, Bogdana; Kreth, Friedrich-Wilhelm; Tonn, Jörg‐Christian; Bartenstein, Peter; Fougère, Christian la; Belka, Claus

doi:10.1016/j.radonc.2011.03.001

Cited by 125 publications

(108 citation statements)

References 29 publications

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“…A regimen of 50 Gy in 1.8 Gy fractions was superior to best supportive care in patients 70 years or older. 29 Patients with adverse prognostic factors defined by age or performance status or both are now commonly treated with hypofractionated RT, e.g., 40 Gy in 15 fractions. 30 In the elderly, this is now the preferred regimen for patients with tumors lacking MGMT promoter methylation.…”

Section: Glioblastoma (Who Grade Iv)mentioning

confidence: 99%

“…Early postoperative DWI MRI may identify ischemic lesions around the surgical cavity. Novel approaches try to base the determination of the target volume on PET using amino acid tracers such as 11 C-MET or 18 F-FET 28,29 or MRI spectroscopy using choline/N-acetylaspartate metabolite cartography. 5,30 Several studies have shown that PET plus MRI will identify a different target volume compared to MRI alone.…”

Section: Radiotherapymentioning

confidence: 99%

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EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

Weller

Bent

Hopkins

et al. 2014

The Lancet Oncology

670

532

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This guideline provides recommendations for diagnostic and therapeutic procedures for patients with malignant gliomas. We differentiate evidence-based standards from reasonable options or non-evidence-based measures that should no longer be considered. The recommendations herein should provide a framework and assurance for the choice of diagnostic procedures and therapeutic measures and aim to reduce complications from unnecessary treatment and cost. The guideline contributes to a critical appreciation of concurrent drugs with a focus on the controlled use of anticonvulsants and steroids. It should serve as a guideline for all professionals involved in the diagnostics and care of glioma patients and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in Europe. Implementation of the recommendations summarised here will need interdisciplinary structures of care for patients with brain tumours and structured processes of diagnostic and therapeutic procedures. AF and DF report no conflicts of interest. FundingThe preparation of this guideline was not funded. The members of the task force did not receive compensation for their participation. 5 SummaryThis guideline provides recommendations for the diagnostic and therapeutic procedures for patients with malignant gliomas. It differentiates evidence-based standards from reasonable options or non-evidence-based measures that should no longer be considered. The recommendations herein shall provide a framework and assurance for the choice of diagnostic procedures and therapeutic measures and aim to reduce complications from unnecessary treatment and cost. The guideline will contribute to a critical appreciation of concurrent medications with a focus on the controlled use of anticonvulsants and steroids. It shall serve as a guideline for all professionals involved in the diagnostics and care of glioma patients and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in Europe. Implementation of the recommendations summarized here will require interdisciplinary structures of care for brain tumor patients and structured processes of diagnostic and therapeutic procedures. Key wordsAnaplastic, glioma, glioblastoma, surgery, radiotherapy, temozolomide, bevacizumab Search strategy and selection criteriaThis guideline was prepared by a task force assembled by the Executive Committee of the European Association for Neuro-Oncology (EANO) in 2013. The task force was designed to represent the different disciplines involved in the diagnosis and care of malignant glioma patients as well as to reflect the multinational composition of EANO.References for this review were identified through searches of PubMed with the search terms "glioma", "anaplastic", "glioblastoma", "trial", "clinical", "radiotherapy" 6 and "chemotherapy" from January 2005 to January 2013. Articles were also identified through searches of the authors` own files. Onl...

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Section: Glioblastoma (Who Grade Iv)mentioning

confidence: 99%

Section: Radiotherapymentioning

confidence: 99%

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

Weller

Bent

Hopkins

et al. 2014

The Lancet Oncology

670

532

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“…13,[33][34][35][36][37][38] Conventional 18 F-FET PET analysis, for example, has been reported to improve biopsy planning and might be also useful for radiotherapy. 13,39 Dynamic analysis of 18 F-FET uptake was shown to enable the differentiation between low-and highgrade gliomas and to distinguish between tumor recurrency and treatment-related effects after adjuvant treatment with high diagnostic power. [11][12][13][40][41][42] Currently, there exists no standard recommendation for initial management of suspected low-grade gliomas.…”

Section: Discussionmentioning

confidence: 99%

Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Thon

Kunz

Lemke

et al. 2014

Intl Journal of Cancer

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In suspected grade II gliomas, three distinct patterns of time-activity curves (TAC) on O-(2-[ positron emission tomography (PET) have been delineated (i) increasing TAC homogeneously throughout the tumor, and decreasing TAC, (ii) either homogeneously throughout the tumor or (iii) only focally within otherwise increasing TAC patterns.Increasing TAC was associated with low-grade histology and decreasing TAC with high-grade histology. This prospective study analyzed whether these patterns correlate with distinct biological tumor subtypes and differential outcome. 18 F-FET PET-guided biopsies were used for stepwise histopathological evaluation. Molecular-genetic evaluation included O 6 -methylguanine-DNA methyltransferase (MGMT) promoter methylation, isocitrate dehydrogenase (IDH1/2) mutational and 1p/19q codeletion status. Progression-free survival (PFS) was estimated with the Kaplan-Meier method. Prognostic factors were obtained from multivariate regression models. 98 adult patients were included. Homogeneous increasing, focal decreasing and homogeneous decreasing TAC were seen in 51, 19 and 28 patients. The corresponding 1-year (2-years) PFS were 92% (85%), 89% (51%) and 50% (28%; p 5 0.002). IDH1/2 mutations were more frequent in tumors with homogeneous increasing (90%) and focal decreasing (79%) TAC, but were rare in those exhibiting homogeneous decreasing TAC (25%; p < 0.001). Overall, TAC patterns, IDH1/2 mutational and 1p/19q codeletion status were powerful and independent prognostic factors. Dynamic 18 F-FET PET might be an important and independent imaging biomarker for patients with suspected WHO grade II gliomas and offers perspectives for stratified diagnostic and therapeutic strategies. Tumors with focal decreasing TAC need highly targeted surgical interventions to avoid undergrading and undertreatment.

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“…Therefore, the fluorinated amino acid analog 18 F-FET has emerged as a powerful complementary tool for glioma imaging (21,22). 18 F-FET PET was shown to be useful for biopsy and treatment planning by accurate delineation of the tumor borders and demarcation of most malignant tumor parts (11,21,(23)(24)(25) and for subsequent treatment monitoring including differentiation between benign therapyinduced changes and tumor recurrence (13,18,(26)(27)(28). Furthermore, the additional use of kinetic analysis of 18 F-FET PET was shown to enable more accurate tumor grading, even in individual patients: increasing time-activity curves are considered to be associated with less malignant low-grade glioma tissue, whereas decreasing timeactivity curves were shown to be prevalent in more aggressive high-grade glioma tissue (9,10).…”

Section: Discussionmentioning

confidence: 99%

Dynamic ¹⁸F-FET PET in Newly Diagnosed Astrocytic Low-Grade Glioma Identifies High-Risk Patients

Jansen¹,

Suchorska

Wenter³

et al. 2013

J Nucl Med

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128

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Because the clinical course of low-grade gliomas in the individual adult patient varies considerably and is unpredictable, we investigated the prognostic value of dynamic 18 F-fluorethyltyrosine ( 18 F-FET) PET in the early diagnosis of astrocytic low-grade glioma (World Health Organization grade II). Methods: Fifty-nine patients with newly diagnosed low-grade glioma and dynamic 18 F-FET PET before histopathologic assessment were retrospectively investigated. 18 F-FET PET analysis comprised a qualitative visual classification of lesions; assessment of the semiquantitative parameters maximal, mean, and total standardized uptake value as ratio to background and biologic tumor volume; and dynamic analysis of intratumoral 18 F-FET uptake over time (increasing vs. decreasing time-activity curves). The correlation between PET parameters and progression-free survival, overall survival, and time to malignant transformation was investigated. Results: 18 F-FET uptake greater than the background level was found in 34 of 59 tumors. Dynamic 18 F-FET uptake analysis was available for 30 of these 34 patients. Increasing and decreasing timeactivity curves were found in 18 and 12 patients, respectively. Neither the qualitative factor presence or absence of 18 F-FET uptake nor any of the semiquantitative uptake parameters significantly influenced clinical outcome. In contrast, decreasing time-activity curves in the kinetic analysis were highly prognostic for shorter progression-free survival and time to malignant transformation (P , 0.001). Conclusion: Absence of 18 F-FET uptake in newly diagnosed astrocytic low-grade glioma does not generally indicate an indolent disease course. Among the 18 F-FET-positive gliomas, decreasing time-activity curves in dynamic 18 F-FET PET constitute an unfavorable prognostic factor in astrocytic low-grade glioma and, by identifying high-risk patients, may ease treatment decisions.

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FET–PET for malignant glioma treatment planning

Cited by 125 publications

References 29 publications

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Dynamic ¹⁸F-FET PET in Newly Diagnosed Astrocytic Low-Grade Glioma Identifies High-Risk Patients

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FET–PET for malignant glioma treatment planning

Cited by 125 publications

References 29 publications

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

Dynamic 18F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Dynamic 18F-FET PET in Newly Diagnosed Astrocytic Low-Grade Glioma Identifies High-Risk Patients

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Product

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Dynamic ¹⁸F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

Dynamic ¹⁸F-FET PET in Newly Diagnosed Astrocytic Low-Grade Glioma Identifies High-Risk Patients