The prognostic value of [123I]-vascular endothelial growth factor ([123I]-VEGF) in glioma

Abstract

PurposeRecent studies have shown that tumor vascular endothelial cells and various tumor cells overexpress receptors for vascular endothelial growth factor (VEGF). The aim of this study was to investigate the prognostic value of [123I]-VEGF scintigraphy in patients with histologically verified brain tumors.Methods23 consecutive patients (9 women and 14 men aged 30–83 years, mean age 56.6 ± 14.4 years) with histopathologically-verified primary brain tumors were included in the study. All patients had undergone [123I]-VEGF scintigraphy. SPECT examinations of brain were performed 30 min and 18 h after injection. Additional [11C]-methionine PET ([11C]-MET PET) was performed in eight of the 23 patients. Both [123I]-VEGF and [11C]-MET PET were evaluated visually and semiquantitatively by tumor-to-normal brain uptake ratio (T/N ratio). Thresholds of the T/N ratio were evaluated by analysis of receiver operating characteristics (ROC). Overall survival (OS) was estimated using the Kaplan-Meier method.ResultsWorld Health Organization (WHO) grade IV glioma lesions showed [123I]-VEGF uptake 18 h after the injection, whereas other brain tumors of grade II or III showed negative results. There was no significant difference in the tumor size between VEGF positive and VEGF negative tumors. Patients with [123I]-VEGF T/N ratio threshold <1.32 showed significantly longer survival than patients with T/N ratio ≥ 1.32 (2680 days vs 295 days; P < 0.05). In the subgroup of 16 grade IV glioma patients, significant OS differences were found using a T/N ratio of 1.75 as threshold (T/N ratio < 1.75: 720 days; T/N ≥ 1.75: 183 days; P < 0.05). Significant difference (P < 0.05) was also found in [11C]-MET PET T/N ratios between the grade IV glioma (mean T/N ratio: 3.71) and the grade II or III glioma (mean T/N ratio: 1.74).ConclusionOur results suggest that [123I]-VEGF scintigraphy may be useful for visualization of tumor angiogenesis. In addition, [123I]-VEGF may provide relevant prognostic information in patients with glioma.

Non-Invasive Estimation of Glioma IDH1 Mutation and VEGF Expression by Histogram Analysis of Dynamic Contrast-Enhanced MRI

“…Moreover, a study has reported that IDH mutation inhibited PI3K/Akt signaling and reduced the HIF expression level (4). Vascular endothelial growth factor (VEGF) regulated by HIF is one of the angiogenesis-related genes, and its over-expression correlates with poor prognoses in gliomas (5,6). So, anti-VEGF therapy increases progression-free survival and improves quality of life in patients with glioma (7,8).…”

The Role of VEGF Receptors as Molecular Target in Nuclear Medicine for Cancer Diagnosis and Combination Therapy

“…The literature shows that there are also descriptions of therapeutic radionuclide ( 177 Lu and 188 Re) in labelled VEGF derivatives [ 136 , 137 , 138 ]. VEGF-A-based radiocompounds are used extensively for selective imaging of VEGFR overexpressions, but also, inter alia, for therapy monitoring [ 139 ], new tracers search [ 140 ], estimation of tumour vascularity [ 141 ], correlation between receptor density and disease progression [ 142 ] or as a prognostic marker for treatment progress evaluation [ 143 ].…”

“…Clinical applications of VEGF-A 165 -based radiocompound, [ 123 I]I-VEGF-A 165 for scintigraphic tumour localisation was evaluated in patients with gastrointestinal tumours [ 177 ], pancreatic carcinoma [ 178 ], highly malignant osteosarcoma [ 179 ] and various grades primary brain tumours [ 143 ]. The results showed fast and different uptake in various lesions; however, contrary to CT and MRI, SPECT imaging detection of existing tumours and metastases was the least sensitive [ 177 ].…”

Current Landscape and Emerging Fields of PET Imaging in Patients with Brain Tumors

“…In adult glioblastoma patients, it has been demonstrated that accumulation of [ 123 I]VEGF in the tumor region of glioblastomas can be assessed using single photon emission computed tomography (SPECT) imaging [149]. Importantly, high uptake of [ 123 I]VEGF was able to identify glioblastoma patients with a poor clinical outcome.…”