Current status of PET imaging in neuro-oncology

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Abstract

Over the past decades, a variety of PET tracers have been used for the evaluation of patients with brain tumors. For clinical routine, the most important clinical indications for PET imaging in patients with brain tumors are the identification of neoplastic tissue including the delineation of tumor extent for the further diagnostic and therapeutic management (ie, biopsy, resection, or radiotherapy planning), the assessment of response to a certain anticancer therapy including its (predictive) effect on the patients’ outcome and the differentiation of treatment-related changes (eg, pseudoprogression and radiation necrosis) from tumor progression at follow-up. To serve medical professionals of all disciplines involved in the diagnosis and care of patients with brain tumors, this review summarizes the value of PET imaging for the latter-mentioned 3 clinically relevant indications in patients with glioma, meningioma, and brain metastases.

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Most cited references 79

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Response criteria for phase II studies of supratentorial malignant glioma.

D R Macdonald, T L Cascino, S C Schold … (1990)

We suggest "new" response criteria for phase II studies of supratentorial malignant glioma and favor rigorous criteria similar to those in medical oncology, with important modifications. Four response categories are proposed: complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Response in this scheme is based on major changes in tumor size on the enhanced computed tomographic (CT) or magnetic resonance imaging (MRI) scan. Scan changes are interpreted in light of steroid use and neurologic findings. We advocate careful patient selection, emphasize pitfalls in the assessment of response, and suggest guidelines to minimize misinterpretations of response.

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Joint EANM/EANO/RANO practice guidelines/SNMMI procedure standards for imaging of gliomas using PET with radiolabelled amino acids and [ 18 F]FDG: version 1.0

Ian Law, Nathalie L. Albert, Javier Arbizu … (2018)

These joint practice guidelines, or procedure standards, were developed collaboratively by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neurooncology (EANO), and the working group for Response Assessment in Neurooncology with PET (PET-RANO). Brain PET imaging is being increasingly used to supplement MRI in the clinical management of glioma. The aim of these standards/guidelines is to assist nuclear medicine practitioners in recommending, performing, interpreting and reporting the results of brain PET imaging in patients with glioma to achieve a high-quality imaging standard for PET using FDG and the radiolabelled amino acids MET, FET and FDOPA. This will help promote the appropriate use of PET imaging and contribute to evidence-based medicine that may improve the diagnostic impact of this technique in neurooncological practice. The present document replaces a former version of the guidelines published in 2006 (Vander Borght et al. Eur J Nucl Med Mol Imaging. 33:1374–80, 2006), and supplements a recent evidence-based recommendation by the PET-RANO working group and EANO on the clinical use of PET imaging in patients with glioma (Albert et al. Neuro Oncol. 18:1199–208, 2016). The information provided should be taken in the context of local conditions and regulations.

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Meningioma: analysis of recurrence and progression following neurosurgical resection.

R O Mirimanoff, D E Dosoretz, R M Linggood … (1985)

The rates of survival, tumor recurrence, and tumor progression were analyzed in 225 patients with meningioma who underwent surgery as the only treatment modality between 1962 and 1980. Patients were considered to have a recurrence if their studies verified a mass effect in spite of a complete surgical removal, whereas they were defined as having progression if, after a subtotal excision, there was clear radiological documentation of an increase in the size of their tumor. There were 168 females and 57 males (a ratio of 2.9:1), with a peak incidence of tumor occurrence in the fifth (23%), sixth (29%), and seventh (23%) decades of life. Anatomical locations were the convexity (21%), parasagittal area (17%), sphenoid ridge (16%), posterior fossa (14%), parasellar region (12%), olfactory groove (10%), spine (8%), and orbit (2%). The absolute 5-, 10-, and 15-year survival rates were 83%, 77%, and 69%, respectively. Following a total resection, the recurrence-free rate at 5, 10, and 15 years was 93%, 80%, and 68%, respectively, at all sites. In contrast, after a subtotal resection, the progression-free rate was only 63%, 45%, and 9% during the same period (p less than 0.0001). The probability of having a second operation following a total excision after 5, 10, and 15 years was 6%, 15%, and 20%, whereas after a subtotal excision the probability was 25%, 44%, and 84%, respectively (p less than 0.0001). Tumor sites associated with a high percentage of total excisions had a low recurrence/progression rate. For example, 96% of convexity meningiomas were removed in toto, and the recurrence/progression rate at 5 years was only 3%. Parasellar meningiomas, with a 57% total excision rate, had a 5-year probability of recurrence/progression of 19%. Only 28% of sphenoid ridge meningiomas a second resection, the probability of a third operation at 5 and 10 years was 42% and 56%, respectively. There was no difference in the recurrence/progression rates according to the patients' age or sex, or the duration of symptoms. Implications for the potential role of adjunctive medical therapy or radiation therapy for meningiomas are discussed.

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Author and article information

Journal

Journal ID (nlm-ta): Neurooncol Adv

Journal ID (iso-abbrev): Neurooncol Adv

Journal ID (publisher-id): noa

Title: Neuro-oncology Advances

Publisher: Oxford University Press (US )

ISSN (Electronic): 2632-2498

Publication date Collection: May-Dec 2019

Publication date (Electronic): 28 May 2019

Publication date PMC-release: 28 May 2019

Volume: 1

Issue: 1

Electronic Location Identifier: vdz010

Affiliations

[1 ] Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne , Germany

[2 ] Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich , Juelich, Germany

[3 ] Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf , Germany

[4 ] Department of Nuclear Medicine, Ludwig Maximilians-University of Munich , Munich, Germany

[5 ] Department of Neurosurgery, Ludwig Maximilians-University of Munich , Munich, Germany

[6 ] German Cancer Consortium (DKTK), Partner Site Munich , Germany

[7 ] Department of Nuclear Medicine, University Hospital Aachen , Aachen, Germany

Author notes

Corresponding Author: Norbert Galldiks, MD, Institute of Neuroscience and Medicine, Research Center Juelich, Leo-Brandt-St. 5, 52425 Juelich, Germany ( n.galldiks@ 123456fz-juelich.de ; norbert.galldiks@ 123456uk-koeln.de ).

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Publisher ID: vdz010

DOI: 10.1093/noajnl/vdz010

PMC ID: 7324052

PubMed ID: 32642650

SO-VID: b9fd953b-d7f9-43a4-be02-2478c44826eb

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Pages: 11

Funding

Funded by: Wilhelm-Sander Stiftung, Germany;

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Current status of PET imaging in neuro-oncology

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Most cited references 79

Response criteria for phase II studies of supratentorial malignant glioma.

Joint EANM/EANO/RANO practice guidelines/SNMMI procedure standards for imaging of gliomas using PET with radiolabelled amino acids and [ 18 F]FDG: version 1.0

Meningioma: analysis of recurrence and progression following neurosurgical resection.

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