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      Serial O-(2-[ 18F]fluoroethyl)-L-tyrosine PET for monitoring the effects of intracavitary radioimmunotherapy in patients with malignant glioma

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          Abstract

          Purpose

          Intracavitary radioimmunotherapy (RIT) offers an effective adjuvant therapeutic approach in patients with malignant gliomas. Since differentiation between recurrence and reactive changes following RIT has a critical impact on patient management, the aim of this study was to analyse the value of serial O-(2-[ 18F]fluoroethyl)- l-tyrosine (FET) PET scans in monitoring the effects of this locoregional treatment.

          Methods

          Following conventional therapy, 24 glioma patients (5 WHO III, 19 WHO IV) underwent one to five RIT cycles with either 131I-labelled ( n=19) or 188Re-labelled ( n=5) anti-tenascin antibodies. Patients were monitored with serial FET PET scans (2–12 scans). For semiquantitative evaluation, maximal tumoural uptake (TU max) was evaluated and the ratio to background (BG) was calculated. Results of PET were correlated with histopathological findings ( n=9) and long-term clinical follow-up for up to 87 months.

          Results

          In seven tumour-free patients, PET revealed slightly increasing but homogeneous FET uptake surrounding the resection cavity with a peak up to 18 months following RIT (TU max/BG 2.07±0.25) but stable or decreasing values during further follow-up (last follow-up: TU max/BG 1.63±0.22). Seventeen patients developed regrowth of residual tumour/tumour recurrence showing additional nodular FET uptake (TU max/BG 2.79±0.53). A threshold value of 2.4 (TU max/BG) allowed best differentiation between recurrence and reactive changes (sensitivity 82%, specificity 100%).

          Conclusion

          FET PET is a sensitive tool for monitoring the effects of locoregional RIT. Homogeneous, slightly increasing FET uptake around the tumour cavity with a peak up to 18 months after RIT, followed by stable or decreasing uptake, points to benign, therapy-related changes. In contrast, nodular uptake is a reliable indicator of recurrence.

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          Most cited references 33

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          Brain tumors.

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            Radiolabeled amino acids: basic aspects and clinical applications in oncology.

            As the applications of metabolic imaging are expanding, radiolabeled amino acids may gain increased clinical interest. This review first describes the basic aspects of amino acid metabolism, then continues with basic aspects of radiolabeled amino acids, and finally describes clinical applications, with an emphasis on diagnostic value. A special focus is on (11)C-methionine, (11)C-tyrosine, and (123)I-iodomethyltyrosine, because these have been most used clinically, although their common affinity for the L-transport systems may limit generalization to other classes of amino acids. The theoretic and preclinical background of amino acid imaging is sound and supports clinical applications. The fact that amino acid imaging is less influenced by inflammation may be advantageous in comparison with (18)F-FDG PET imaging, although tumor specificity is not absolute. In brain tumor imaging, the use of radiolabeled amino acids is established, the diagnostic accuracy of amino acid imaging seems adequate, and the diagnostic value seems advantageous. The general feasibility of amino acid imaging in other tumor types has sufficiently been shown, but more research is required in larger patient series and in well-defined clinical settings.
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              Survival rates in patients with primary malignant brain tumors stratified by patient age and tumor histological type: an analysis based on Surveillance, Epidemiology, and End Results (SEER) data, 1973-1991.

              The authors present population-based survival rate estimates for patients with malignant primary brain tumors based on an analysis of 18 years of data obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Estimates of survival rates at 2 and 5 years after diagnosis for patients with specific histological tumor types were categorized by patient's age at diagnosis (< or = 20 years, 21-64 years, and 65 years or older) and by the time period in which the patients were diagnosed (1973-1980, 1981-1985, 1986-1991). Where appropriate, survival estimates were adjusted for changing patterns in the mean age at diagnosis. The authors observed a pattern of declining survival rates in patients with increasing age of the patient at diagnosis for most histological groups and overall improvements in survival rates of patients across these time periods adjusting for age at diagnosis. There were improvements in 2- and 5-year survival rates over the three time periods for children and adults with medulloblastoma and for adults with astrocytoma and oligodendroglioma. Improvements in survival rates for pediatric patients with medulloblastoma have leveled off in the most recent time period, and gender differences in survival rates for patients with this tumor, which were present in the 1970s, have disappeared. Clinically significant improvements in survival rates were not apparent in patients aged 65 years and older. Changes in diagnostic and treatment procedures since the mid-1970s have resulted in improved survival rates for patients diagnosed as having medulloblastoma, oligodendroglioma, and astrocytoma, controlling for age at diagnosis. Glioblastoma multiforme continues to be the most intractable brain tumor.
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                Author and article information

                Contributors
                +49-89-70954646 , +49-89-70957646 , Gabriele.Poepperl@med.uni-muenchen.de
                Journal
                Eur J Nucl Med Mol Imaging
                European Journal of Nuclear Medicine and Molecular Imaging
                Springer-Verlag (Berlin/Heidelberg )
                1619-7070
                1619-7089
                21 March 2006
                July 2006
                : 33
                : 7
                : 792-800
                Affiliations
                [1 ]Department of Nuclear Medicine, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
                [2 ]Department of Neurosurgery, Klinikum Grosshadern, University of Munich, Munich, Germany
                Article
                53
                10.1007/s00259-005-0053-7
                1998889
                16550381
                © Springer-Verlag 2006
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag 2006

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