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      Larger 18F-fluoroboronotyrosine (FBY) active volume beyond MRI contrast enhancement in diffuse gliomas than in circumscribed brain tumors

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          Abstract

          Background

          To investigate the relationship between 18F-fluoroboronotyrosine (FBY) positron emission tomography (PET)- and magnetic resonance imaging (MRI)-defined tumor volumes in contrast-enhanced diffuse gliomas and circumscribed brain tumors.

          Methods

          A total of 16 diffuse gliomas and 7 circumscribed brain tumors were included, and two types of three-dimensional regions of interest (ROIs), namely, MRI-based ROI (ROI MRI) and FBY-based ROI (ROI FBY), were semiautomatically defined. The overlap volume and DICE score were calculated to reveal the spatial relationship between the ROI MRI and ROI FBY.

          Results

          The ROI MRI was smaller than the ROI FBY and was mostly contained by the ROI FBY with an overlap volume of 0.995 ± 0.006 in the whole population. A significant difference in the DICE score was observed between circumscribed tumors and diffuse tumors (0.886 ± 0.026 vs. 0.684 ± 0.165, p = 0.004), and for the regions that have increased FBY metabolism but not MRI contrast enhancement, diffuse tumors and circumscribed tumors showed similar SUVmean values (0.630 ± 0.19 vs. 0.671 ± 0.18, p = 0.625).

          Conclusion

          FBY uptake beyond contrast enhancement is more significant in diffuse tumors than in circumscribed tumors, which may aid the delineation of active tumor areas and facilitate boron neutron capture therapy.

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          Most cited references22

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          The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary.

          The 2016 World Health Organization Classification of Tumors of the Central Nervous System is both a conceptual and practical advance over its 2007 predecessor. For the first time, the WHO classification of CNS tumors uses molecular parameters in addition to histology to define many tumor entities, thus formulating a concept for how CNS tumor diagnoses should be structured in the molecular era. As such, the 2016 CNS WHO presents major restructuring of the diffuse gliomas, medulloblastomas and other embryonal tumors, and incorporates new entities that are defined by both histology and molecular features, including glioblastoma, IDH-wildtype and glioblastoma, IDH-mutant; diffuse midline glioma, H3 K27M-mutant; RELA fusion-positive ependymoma; medulloblastoma, WNT-activated and medulloblastoma, SHH-activated; and embryonal tumour with multilayered rosettes, C19MC-altered. The 2016 edition has added newly recognized neoplasms, and has deleted some entities, variants and patterns that no longer have diagnostic and/or biological relevance. Other notable changes include the addition of brain invasion as a criterion for atypical meningioma and the introduction of a soft tissue-type grading system for the now combined entity of solitary fibrous tumor / hemangiopericytoma-a departure from the manner by which other CNS tumors are graded. Overall, it is hoped that the 2016 CNS WHO will facilitate clinical, experimental and epidemiological studies that will lead to improvements in the lives of patients with brain tumors.
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            Currently, the most widely used criteria for assessing response to therapy in high-grade gliomas are based on two-dimensional tumor measurements on computed tomography (CT) or magnetic resonance imaging (MRI), in conjunction with clinical assessment and corticosteroid dose (the Macdonald Criteria). It is increasingly apparent that there are significant limitations to these criteria, which only address the contrast-enhancing component of the tumor. For example, chemoradiotherapy for newly diagnosed glioblastomas results in transient increase in tumor enhancement (pseudoprogression) in 20% to 30% of patients, which is difficult to differentiate from true tumor progression. Antiangiogenic agents produce high radiographic response rates, as defined by a rapid decrease in contrast enhancement on CT/MRI that occurs within days of initiation of treatment and that is partly a result of reduced vascular permeability to contrast agents rather than a true antitumor effect. In addition, a subset of patients treated with antiangiogenic agents develop tumor recurrence characterized by an increase in the nonenhancing component depicted on T2-weighted/fluid-attenuated inversion recovery sequences. The recognition that contrast enhancement is nonspecific and may not always be a true surrogate of tumor response and the need to account for the nonenhancing component of the tumor mandate that new criteria be developed and validated to permit accurate assessment of the efficacy of novel therapies. The Response Assessment in Neuro-Oncology Working Group is an international effort to develop new standardized response criteria for clinical trials in brain tumors. In this proposal, we present the recommendations for updated response criteria for high-grade gliomas.
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              Primary brain tumours in adults

              Primary CNS tumours refer to a heterogeneous group of tumours arising from cells within the CNS, and can be benign or malignant. Malignant primary brain tumours remain among the most difficult cancers to treat, with a 5 year overall survival no greater than 35%. The most common malignant primary brain tumours in adults are gliomas. Recent advances in molecular biology have improved understanding of glioma pathogenesis, and several clinically significant genetic alterations have been described. A number of these (IDH, 1p/19q codeletion, H3 Lys27Met, and RELA-fusion) are now combined with histology in the revised 2016 WHO classification of CNS tumours. It is likely that understanding such molecular alterations will contribute to the diagnosis, grading, and treatment of brain tumours. This progress in genomics, along with significant advances in cancer and CNS immunology, has defined a new era in neuro-oncology and holds promise for diagntic and therapeutic improvement. The challenge at present is to translate these advances into effective treatments. Current efforts are focused on developing molecular targeted therapies, immunotherapies, gene therapies, and novel drug-delivery technologies. Results with single-agent therapies have been disappointing so far, and combination therapies seem to be required to achieve a broad and durable antitumour response. Biomarker-targeted clinical trials could improve efficiencies of therapeutic development.
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                Author and article information

                Contributors
                ywang@pumch.cn
                pekyz@163.com
                zbliu@pku.edu.cn
                Journal
                EJNMMI Res
                EJNMMI Res
                EJNMMI Research
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2191-219X
                18 April 2022
                18 April 2022
                2022
                : 12
                : 22
                Affiliations
                [1 ]GRID grid.413106.1, ISNI 0000 0000 9889 6335, Department of Neurosurgery, , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ; Beijing, China
                [2 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, , Chinese Academy of Medical Sciences and Peking Union Medical College, ; Beijing, China
                [3 ]GRID grid.412474.0, ISNI 0000 0001 0027 0586, Key Laboratory of Carcinogenesis and Translational Research, Department of Nuclear Medicine, , Peking University Cancer Hospital and Institute, ; Beijing, China
                [4 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, Beijing National Laboratory for Molecular Sciences, Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals, Key Laboratory of Bioorganic Chemistry and Molecular Engineering of Ministry of Education, College of Chemistry and Molecular Engineering, , Peking University, ; Beijing, China
                [5 ]GRID grid.452723.5, ISNI 0000 0004 7887 9190, Peking University-Tsinghua University Center for Life Sciences, ; Beijing, China
                Author information
                http://orcid.org/0000-0002-5587-4165
                Article
                896
                10.1186/s13550-022-00896-w
                9016106
                35435593
                7879c3bf-428a-4e67-b298-10583720f4aa
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 24 January 2022
                : 10 April 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100002855, Ministry of Science and Technology of the People's Republic of China;
                Award ID: 2021YFA1601400
                Award ID: 2017YFA0506300
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100005089, Beijing Municipal Natural Science Foundation;
                Award ID: 7202150
                Award ID: Z200018
                Award ID: 19JCZDJC64200(Z)
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100002888, Beijing Municipal Commission of Education;
                Award ID: 3500-12020123
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: U1867209
                Award ID: 21778003
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100007937, Peking University;
                Award ID: LGZNQN202004
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100004147, Tsinghua University;
                Award ID: 2019ZLH101
                Award Recipient :
                Categories
                Short Communication
                Custom metadata
                © The Author(s) 2022

                Radiology & Imaging
                fluoroboronotyrosine,pet,brain tumor,diffuse glioma,metastasis,volume comparison,boron neutron capture therapy

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