scholarly journals Feasibility study of finalizing the extended adjuvant temozolomide based on methionine positron emission tomography (Met-PET) findings in patients with glioblastoma

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Seiichiro Hirono ◽  
Yuzo Hasegawa ◽  
Tsukasa Sakaida ◽  
Yoshio Uchino ◽  
Kazuo Hatano ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Tumor Progression ◽  
Recurrence Rate ◽  
Tumor Recurrence ◽  
Emission Tomography ◽  
Adjuvant Temozolomide ◽  
Positron Emission ◽  
Methionine Uptake ◽  
One Year ◽  
Met Pet

AbstractIn the management of patients with newly diagnosed glioblastoma, there is no standard duration for adjuvant temozolomide treatment. This study aimed to assess the feasibility of finalizing adjuvant temozolomide treatment on the basis of methionine uptake in methionine positron emission tomography (Met-PET). We conducted a retrospective review of glioblastoma patients who underwent more than twelve cycles of temozolomide (extended temozolomide) treatment after resection and concomitant chemoradiotherapy with no evidence of recurrence on MRI. In addition to the methionine uptake value at the completion of extended temozolomide, local and distant recurrence and progression-free survival were also analyzed. Forty-four patients completed the extended temozolomide treatment. Among these, 18 experienced some type of tumor recurrence within one year. A Tmax/Nave value of 2.0 was the optimal cut-off value indicating progression. More than 80% of the patients with low methionine uptake completed the temozolomide treatment, and subsequent basic MRI observations showed no recurrence within one year after Met-PET. Subgroups with high uptake (≥2.0), even with continuation of temozolomide treatment, showed more frequent tumor progression than patients with low uptake (<2.0) who completed the extended temozolomide treatment (p < 0.001, odds ratio 14.7, 95% CI 3.46–62.3). The tumor recurrence rate increased in stepwise manner according to methionine uptake. Finalization of the extended temozolomide treatment on the basis of low uptake value was feasible with a low recurrence rate. Compared to MRI, Met-PET shows better ability to predict tumor progression in long-term glioblastoma survivors with extended temozolomide use.

scholarly journals Usefulness of 11C-Methionine Positron Emission Tomography for Monitoring of Treatment Response and Recurrence in a Glioblastoma Patient on Bevacizumab Therapy: A Case Report

2018 ◽  
Vol 11 (2) ◽  
pp. 442-449
Author(s):  
Tomoyuki Nakano ◽  
Kaoru Tamura ◽  
Yoji Tanaka ◽  
Motoki Inaji ◽  
Shihori Hayashi ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Complete Remission ◽  
Tumor Progression ◽  
Response Assessment ◽  
Recurrent Glioblastoma ◽  
Emission Tomography ◽  
Left Frontal Lobe ◽  
Positron Emission ◽  
Magnetic Resonance Imaging Mri ◽  
Met Pet

Recently developed molecular targeted therapies such as bevacizumab (BEV; Avastin) therapy have therapeutic efficacy for glioblastoma. However, it is difficult to distinguish between a tumor response and nonenhancing tumor progression with conventional magnetic resonance imaging (MRI) after BEV administration. Here we present a recurrent glioblastoma case in which 11C-methionine positron emission tomography (MET-PET) provided useful information for detecting tumor recurrence after complete remission, as assessed by the Response Assessment in Neuro-Oncology criteria. A 47-year-old male with a left frontal lobe glioblastoma experienced recurrence 6 months postoperatively. We administered BEV concomitantly with temozolomide, subsequent to gamma knife surgery. Two months after starting BEV, complete remission was obtained. MET uptake on PET gradually decreased and had nearly disappeared 4 months after initiating BEV. No enhanced area was seen on MRI for 17 months after BEV initiation. Nevertheless, MET-PET revealed recurrence, visualized as nonenhancing tumor progression. MET-PET provides useful information for detecting glioblastoma recurrence, which lacks contrast enhancement on MRI after BEV therapy.

The Value of Positron Emission Tomography for Differentiating Brain Tumor Progression and Treatment-Induced Changes

2020 ◽  
pp. 1067-1081
Author(s):  
Bart R. J. van Dijken ◽  
Roelien H. Enting ◽  
Hanne-Rinck Jeltema ◽  
Miranda C. A. Kramer ◽  
Rudi A. J. O. Dierckx ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Brain Tumor ◽  
Tumor Progression ◽  
Emission Tomography ◽  
Positron Emission ◽  
Induced Changes

scholarly journals Accurate Detection of Tumor Infiltration by 11C-Methionine Positron Emission Tomography in a Patient with Central Nervous System Intravascular Lymphoma: A Case Report

2018 ◽  
Vol 11 (2) ◽  
pp. 577-584 ◽  
Author(s):  
Shoji Yomo ◽  
Keiji Tsutsumi ◽  
Takehiro Yako ◽  
Hiromasa Sato ◽  
Takao Hashimoto ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Central Nervous System ◽  
Nervous System ◽  
B Cell Lymphoma ◽  
Emission Tomography ◽  
Serum Lactate Dehydrogenase ◽  
Tumor Infiltration ◽  
Intravascular Lymphoma ◽  
Positron Emission ◽  
Met Pet

Intravascular lymphoma (IVL) is a rare and clinically devastating subtype of extranodal diffuse large B-cell lymphoma with a distinct presentation. Diagnostic difficulty derives from marked variability in clinical presentations and nonspecific laboratory and radiological findings, especially when central nervous system (CNS) symptoms are the only manifestation. Establishing the diagnosis premortem thus remains a major challenge. We describe a 70-year-old male with CNS IVL. He presented with acute onset of neurocognitive impairments. Diffusion-weighted magnetic resonance imaging (MRI) showed multiple high-intensity areas suggesting occlusive cerebrovascular disease due to emboli, but extensive investigations detected no embolic sources. Intracranial neoplasm was included in a differential diagnosis based on elevated serum lactate dehydrogenase and interleukin 2 receptor levels. Gadolinium-enhanced MRI or 18-fluorodeoxyglucose positron emission tomography (PET) failed to demonstrate specific findings leading to a definite diagnosis, while 11C-methionine PET (MET-PET) distinctively demonstrated an area of focally increased MET uptake in the frontal cortex, suggesting the extent of tumor infiltration. Stereotactic biopsy was conducted under MET-PET imaging guidance and immunohistological examinations confirmed the proliferation and aggregation of CD20-positive lymphoma cells within the lumina of small blood vessels. The findings of the present case first suggest that MET-PET may provide important information on the diagnosis of CNS IVL and on the selection of the optimal site for brain biopsy. Further investigation is necessary to clarify whether positive findings on MET-PET are truly specific and pathognomonic for CNS IVL.

scholarly journals [11C]-Methionine Positron Emission Tomography in the Postoperative Imaging and Followup of Patients with Primary and Recurrent Gliomas

ISRN Oncology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Matteo Santoni ◽  
Cristina Nanni ◽  
Alessandro Bittoni ◽  
Gabriele Polonara ◽  
Alessandro Paccapelo ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Residual Disease ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
High Sensitivity ◽  
Emission Tomography ◽  
Low Grade ◽  
Postoperative Imaging ◽  
Positron Emission ◽  
Met Pet

We investigated the sensitivity and specificity of [11C]-methionine positron emission tomography ([11C]-MET PET) in the management of glioma patients. We retrospectively analysed data from 53 patients with primary gliomas (16 low grade astrocytomas, 15 anaplastic astrocytomas and 22 glioblastomas) and Karnofsky Performance Status (KPS) > 70. Patients underwent [11C]-MET PET scans (N=249) and parallel contrast-enhanced MRI (N=193) and/or CT (N=113) controls. In low grade glioma patients, MRI or CT findings associated with [11C]-MET PET additional data allowed discrimination residual disease from postsurgical changes in 96.22% of these cases. [11C]-MET PET early allowed detection of malignant progression from low grade to anaplastic astrocytoma with high sensitivity (91.56%) and specificity (95.18%). In anaplastic astrocytomas, we registered high sensitivity (93.97%) and specificity (95.18%) in the postoperative imaging and during the followup of these patients. In GBM patients, CT and/or MRI scans with additional [11C]-MET PET data registered a sensitivity of 96.92% in the postsurgical evaluation and in the tumour assessment during temozolomide therapy. A significant correlation was found between [11C]-MET mean uptake index and histologic grading (P<0.001). These findings support the notion that complementary information derived from [11C]-MET PET may be helpful in postoperative and successive tumor assessment of glioma patients.

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