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Langen KJ, Heinzel A, Lohmann P, Mottaghy FM, Galldiks N. Advantages and limitations of amino acid PET for tracking therapy response in glioma patients. Expert Rev Neurother 2019; 20:137-146. [DOI: 10.1080/14737175.2020.1704256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, INM-4), Forschungszentrum Juelich, Juelich, Germany
- Department of Nuclear Medicine, University of Aachen, Aachen, Germany
- Section JARA-Brain, Juelich-Aachen Research Alliance (JARA), Juelich-Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Alexander Heinzel
- Department of Nuclear Medicine, University of Aachen, Aachen, Germany
- Section JARA-Brain, Juelich-Aachen Research Alliance (JARA), Juelich-Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, INM-4), Forschungszentrum Juelich, Juelich, Germany
| | - Felix M. Mottaghy
- Department of Nuclear Medicine, University of Aachen, Aachen, Germany
- Section JARA-Brain, Juelich-Aachen Research Alliance (JARA), Juelich-Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
- Centre of Integrated Oncology (CIO), Universities of Aachen, Düsseldorf, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3, INM-4), Forschungszentrum Juelich, Juelich, Germany
- Department of Neurology1, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Centre of Integrated Oncology (CIO), Universities of Aachen, Düsseldorf, Germany
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2
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McIntosh A, Mela V, Harty C, Minogue AM, Costello DA, Kerskens C, Lynch MA. Iron accumulation in microglia triggers a cascade of events that leads to altered metabolism and compromised function in APP/PS1 mice. Brain Pathol 2019; 29:606-621. [PMID: 30661261 DOI: 10.1111/bpa.12704] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/07/2019] [Indexed: 12/25/2022] Open
Abstract
Among the changes that typify Alzheimer's disease (AD) are neuroinflammation and microglial activation, amyloid deposition perhaps resulting from compromised microglial function and iron accumulation. Data from Genome Wide Association Studies (GWAS) identified a number of gene variants that endow a significant risk of developing AD and several of these encode proteins expressed in microglia and proteins that are implicated in the immune response. This suggests that neuroinflammation and the accompanying microglial activation are likely to contribute to the pathogenesis of the disease. The trigger(s) leading to these changes remain to be identified. In this study, we set out to examine the link between the inflammatory, metabolic and iron-retentive signature of microglia in vitro and in transgenic mice that overexpress the amyloid precursor protein (APP) and presenilin 1 (PS1; APP/PS1 mice), a commonly used animal model of AD. Stimulation of cultured microglia with interferon (IFN)γ and amyloid-β (Aβ) induced an inflammatory phenotype and switched the metabolic profile and iron handling of microglia so that the cells became glycolytic and iron retentive, and the phagocytic and chemotactic function of the cells was reduced. Analysis of APP/PS1 mice by magnetic resonance imaging (MRI) revealed genotype-related hypointense areas in the hippocampus consistent with iron deposition, and immunohistochemical analysis indicated that the iron accumulated in microglia, particularly in microglia that decorated Aβ deposits. Isolated microglia prepared from APP/PS1 mice were characterized by a switch to a glycolytic and iron-retentive phenotype and phagocytosis of Aβ was reduced in these cells. This evidence suggests that the switch to glycolysis in microglia may kick-start a cascade of events that ultimately leads to microglial dysfunction and Aβ accumulation.
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Affiliation(s)
- Allison McIntosh
- Trinity College Institute for Neuroscience, Trinity College, Dublin 2, Ireland
| | - Virginia Mela
- Trinity College Institute for Neuroscience, Trinity College, Dublin 2, Ireland
| | - Conor Harty
- Trinity College Institute for Neuroscience, Trinity College, Dublin 2, Ireland
| | - Aedin M Minogue
- Trinity College Institute for Neuroscience, Trinity College, Dublin 2, Ireland
| | - Derek A Costello
- Trinity College Institute for Neuroscience, Trinity College, Dublin 2, Ireland
| | - Christian Kerskens
- Trinity College Institute for Neuroscience, Trinity College, Dublin 2, Ireland
| | - Marina A Lynch
- Trinity College Institute for Neuroscience, Trinity College, Dublin 2, Ireland
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Galldiks N, Law I, Pope WB, Arbizu J, Langen KJ. The use of amino acid PET and conventional MRI for monitoring of brain tumor therapy. Neuroimage Clin 2016; 13:386-394. [PMID: 28116231 PMCID: PMC5226808 DOI: 10.1016/j.nicl.2016.12.020] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/09/2016] [Accepted: 12/16/2016] [Indexed: 12/03/2022]
Abstract
Routine diagnostics and treatment monitoring of brain tumors is usually based on contrast-enhanced MRI. However, the capacity of conventional MRI to differentiate tumor tissue from posttherapeutic effects following neurosurgical resection, chemoradiation, alkylating chemotherapy, radiosurgery, and/or immunotherapy may be limited. Metabolic imaging using PET can provide relevant additional information on tumor metabolism, which allows for more accurate diagnostics especially in clinically equivocal situations. This review article focuses predominantly on the amino acid PET tracers 11C-methyl-l-methionine (MET), O-(2-[18F]fluoroethyl)-l-tyrosine (FET) and 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine (FDOPA) and summarizes investigations regarding monitoring of brain tumor therapy.
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Affiliation(s)
- Norbert Galldiks
- Dept. of Neurology, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany
| | - Ian Law
- Dept.of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Whitney B. Pope
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Javier Arbizu
- Dept. of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany
- Dept. of Nuclear Medicine, University of Aachen, Aachen, Germany
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Galldiks N, Langen KJ. Amino Acid PET - An Imaging Option to Identify Treatment Response, Posttherapeutic Effects, and Tumor Recurrence? Front Neurol 2016; 7:120. [PMID: 27516754 PMCID: PMC4963389 DOI: 10.3389/fneur.2016.00120] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
Routine diagnostics and treatment monitoring in patients with primary and secondary brain tumors is usually based on contrast-enhanced standard MRI. However, the capacity of standard MRI to differentiate neoplastic tissue from non-specific posttreatment effects may be limited particularly after therapeutic interventions such as radio- and/or chemotherapy or newer treatment options, e.g., immune therapy. Metabolic imaging using PET may provide relevant additional information on tumor metabolism, which allows a more accurate diagnosis especially in clinically equivocal situations, particularly when radiolabeled amino acids are used. Amino acid PET allows a sensitive monitoring of a response to various treatment options, the early detection of tumor recurrence, and an improved differentiation of tumor recurrence from posttherapeutic effects. In the past, this method had only limited availability due to the use of PET tracers with a short half-life, e.g., C-11. In recent years, however, novel amino acid PET tracers labeled with positron emitters with a longer half-life (F-18) have been developed and clinically validated, which allow a more efficient and cost-effective application. These developments and the well-documented diagnostic performance of PET using radiolabeled amino acids suggest that its application continues to spread and that this technique may be available as a routine diagnostic tool for several indications in the field of neuro-oncology.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany; Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany; Department of Nuclear Medicine, University of Aachen, Aachen, Germany
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Chung T, Na J, Kim YI, Chang DY, Kim YI, Kim H, Moon HE, Kang KW, Lee DS, Chung JK, Kim SS, Suh-Kim H, Paek SH, Youn H. Dihydropyrimidine Dehydrogenase Is a Prognostic Marker for Mesenchymal Stem Cell-Mediated Cytosine Deaminase Gene and 5-Fluorocytosine Prodrug Therapy for the Treatment of Recurrent Gliomas. Theranostics 2016; 6:1477-90. [PMID: 27446484 PMCID: PMC4955049 DOI: 10.7150/thno.14158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 05/06/2016] [Indexed: 12/23/2022] Open
Abstract
We investigated a therapeutic strategy for recurrent malignant gliomas using mesenchymal stem cells (MSC), expressing cytosine deaminase (CD), and prodrug 5-Fluorocytosine (5-FC) as a more specific and less toxic option. MSCs are emerging as a novel cell therapeutic agent with a cancer-targeting property, and CD is considered a promising enzyme in cancer gene therapy which can convert non-toxic 5-FC to toxic 5-Fluorouracil (5-FU). Therefore, use of prodrug 5-FC can minimize normal cell toxicity. Analyses of microarrays revealed that targeting DNA damage and its repair is a selectable option for gliomas after the standard chemo/radio-therapy. 5-FU is the most frequently used anti-cancer drug, which induces DNA breaks. Because dihydropyrimidine dehydrogenase (DPD) was reported to be involved in 5-FU metabolism to block DNA damage, we compared the survival rate with 5-FU treatment and the level of DPD expression in 15 different glioma cell lines. DPD-deficient cells showed higher sensitivity to 5-FU, and the regulation of DPD level by either siRNA or overexpression was directly related to the 5-FU sensitivity. For MSC/CD with 5-FC therapy, DPD-deficient cells such as U87MG, GBM28, and GBM37 showed higher sensitivity compared to DPD-high U373 cells. Effective inhibition of tumor growth was also observed in an orthotopic mouse model using DPD- deficient U87MG, indicating that DPD gene expression is indeed closely related to the efficacy of MSC/CD-mediated 5-FC therapy. Our results suggested that DPD can be used as a biomarker for selecting glioma patients who may possibly benefit from this therapy.
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Challapalli A, Aboagye EO. Positron Emission Tomography Imaging of Tumor Cell Metabolism and Application to Therapy Response Monitoring. Front Oncol 2016; 6:44. [PMID: 26973812 PMCID: PMC4770188 DOI: 10.3389/fonc.2016.00044] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/12/2016] [Indexed: 12/12/2022] Open
Abstract
Cancer cells do reprogram their energy metabolism to enable several functions, such as generation of biomass including membrane biosynthesis, and overcoming bioenergetic and redox stress. In this article, we review both established and evolving radioprobes developed in association with positron emission tomography (PET) to detect tumor cell metabolism and effect of treatment. Measurement of enhanced tumor cell glycolysis using 2-deoxy-2-[(18)F]fluoro-D-glucose is well established in the clinic. Analogs of choline, including [(11)C]choline and various fluorinated derivatives are being tested in several cancer types clinically with PET. In addition to these, there is an evolving array of metabolic tracers for measuring intracellular transport of glutamine and other amino acids or for measuring glycogenesis, as well as probes used as surrogates for fatty acid synthesis or precursors for fatty acid oxidation. In addition to providing us with opportunities for examining the complex regulation of reprogramed energy metabolism in living subjects, the PET methods open up opportunities for monitoring pharmacological activity of new therapies that directly or indirectly inhibit tumor cell metabolism.
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Affiliation(s)
| | - Eric O. Aboagye
- Department of Surgery and Cancer, Imperial College London, London, UK
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Denysenko T, Gennero L, Juenemann C, Morra I, Masperi P, Ceroni V, Pragliola A, Ponzetto A, Melcarne A. Heterogeneous phenotype of human glioblastoma: in vitro study. Cell Biochem Funct 2013; 32:164-76. [PMID: 23836332 DOI: 10.1002/cbf.2988] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 04/19/2013] [Accepted: 06/04/2013] [Indexed: 01/06/2023]
Abstract
Glioblastomas (GBMs) are the most lethal primary brain tumours. Increasing evidence shows that brain tumours contain the population of stem cells, so-called cancer stem cells (CSCs). Stem cell marker CD133 was reported to identify CSC population in GBM. Further studies have indicated that CD133 negative cells exhibiting similar properties and are able to initiate the tumour, self-renew and undergo multilineage differentiation. GBM is a highly heterogeneous tumour and may contain different stem cell populations with different functional properties. We characterized five GBM cell lines, established from surgical samples, according to the marker expression, proliferation and differentiation potential. CD133 positive cell lines showed increased proliferation rate in neurosphere condition and marked differentiation potential towards neuronal lineages. Whereas two cell lines low-expressing CD133 marker showed mesenchymal properties in vitro, that is high proliferation rate in serum condition and differentiation in mesenchymal cell types. Further, we compared therapy resistance capacity of GBM cell lines treated with hydroxyurea. Our results suggest that CSC concept is more complex than it was believed before, and CD133 could not define entire stem cell population within GBM. At least two different subtypes of GBM CSCs exist, which may have different biological characteristics and imply different therapeutic strategies.
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Galldiks N, Rapp M, Stoffels G, Dunkl V, Sabel M, Langen KJ. Earlier Diagnosis of Progressive Disease during Bevacizumab Treatment Using O-(2-18F-Fluorethyl)-L-Tyrosine Positron Emission Tomography in Comparison with Magnetic Resonance Imaging. Mol Imaging 2013. [DOI: 10.2310/7290.2013.00051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Norbert Galldiks
- From the Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany; and Department of Nuclear Medicine, University of Aachen, Aachen, Germany
| | - Marion Rapp
- From the Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany; and Department of Nuclear Medicine, University of Aachen, Aachen, Germany
| | - Gabriele Stoffels
- From the Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany; and Department of Nuclear Medicine, University of Aachen, Aachen, Germany
| | - Veronika Dunkl
- From the Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany; and Department of Nuclear Medicine, University of Aachen, Aachen, Germany
| | - Michael Sabel
- From the Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany; and Department of Nuclear Medicine, University of Aachen, Aachen, Germany
| | - Karl-Josef Langen
- From the Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany; and Department of Nuclear Medicine, University of Aachen, Aachen, Germany
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Galldiks N, Dunkl V, Kracht LW, Vollmar S, Jacobs AH, Fink GR, Schroeter M. Volumetry of [11C]-Methionine Positron Emission Tomographic Uptake as a Prognostic Marker before Treatment of Patients with Malignant Glioma. Mol Imaging 2012. [DOI: 10.2310/7290.2012.00022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Norbert Galldiks
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; European Institute for Molecular Imaging, University of Munster, Münster, Germany; and Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Veronika Dunkl
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; European Institute for Molecular Imaging, University of Munster, Münster, Germany; and Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Lutz W. Kracht
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; European Institute for Molecular Imaging, University of Munster, Münster, Germany; and Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Stefan Vollmar
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; European Institute for Molecular Imaging, University of Munster, Münster, Germany; and Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Andreas H. Jacobs
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; European Institute for Molecular Imaging, University of Munster, Münster, Germany; and Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Gereon R. Fink
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; European Institute for Molecular Imaging, University of Munster, Münster, Germany; and Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Michael Schroeter
- From the Department of Neurology, University Hospital of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; European Institute for Molecular Imaging, University of Munster, Münster, Germany; and Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
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Galldiks N, von Tempelhoff W, Kahraman D, Kracht LW, Vollmar S, Fink GR, Schroeter M, Goldbrunner R, Schmidt M, Maarouf M. 11C-Methionine Positron Emission Tomographic Imaging of Biologic Activity of a Recurrent Glioblastoma Treated with Stereotaxy-Guided Laser-Induced Interstitial Thermotherapy. Mol Imaging 2012. [DOI: 10.2310/7290.2011.00046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In patients with recurrent glioblastoma multiforme (GBM), local minimally invasive treatment modalities have gained increasing interest recently because they are associated with fewer side effects than open surgery. For example, local tumor coagulation by laser-induced interstitial thermotherapy (LITT) is such a minimally invasive technique. We monitored the metabolic effects of stereotaxy-guided LITT in a patient with a recurrent GBM using amino acid positron emission tomography (PET). Serial 11C-methyl-L-methionine positron emission tomography (MET-PET) and contrast-enhanced computed tomography (CT) were performed using a hybrid PET/CT system in a patient with recurrent GBM before and after LITT. To monitor the biologic activity of the effects of stereotaxy-guided LITT, a threshold-based volume of interest analysis of the metabolically active tumor volume (MET uptake index of ≥ 1.3) was performed. A continuous decline in metabolically active tumor volume after LITT could be observed. MET-PET seems to be useful for monitoring the short-term therapeutic effects of LITT, especially when patients have been pretreated with a multistep therapeutic regimen. MET-PET seems to be an appropriate tool to monitor and guide experimental LITT regimens and should be studied in a larger patient group to confirm its clinical value.
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Affiliation(s)
- Norbert Galldiks
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Wernholt von Tempelhoff
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Deniz Kahraman
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Lutz W. Kracht
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Stefan Vollmar
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Gereon R. Fink
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Michael Schroeter
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Roland Goldbrunner
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Matthias Schmidt
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Mohammad Maarouf
- From the Departments of Neurology, Neurosurgery, Nuclear Medicine, and Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany; Max Planck-Institute for Neurological Research, Cologne, Germany; and Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
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Galldiks N, Langen KJ, Holy R, Pinkawa M, Stoffels G, Nolte KW, Kaiser HJ, Filss CP, Fink GR, Coenen HH, Eble MJ, Piroth MD. Assessment of treatment response in patients with glioblastoma using O-(2-18F-fluoroethyl)-L-tyrosine PET in comparison to MRI. J Nucl Med 2012; 53:1048-57. [PMID: 22645298 DOI: 10.2967/jnumed.111.098590] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The assessment of treatment response in glioblastoma is difficult with MRI because reactive blood-brain barrier alterations with contrast enhancement can mimic tumor progression. In this study, we investigated the predictive value of PET using O-(2-(18)F-fluoroethyl)-l-tyrosine ((18)F-FET PET) during treatment. METHODS In a prospective study, 25 patients with glioblastoma were investigated by MRI and (18)F-FET PET after surgery (MRI-/FET-1), early (7-10 d) after completion of radiochemotherapy with temozolomide (RCX) (MRI-/FET-2), and 6-8 wk later (MRI-/FET-3). Maximum and mean tumor-to-brain ratios (TBR(max) and TBR(mean), respectively) were determined by region-of-interest analyses. Furthermore, gadolinium contrast-enhancement volumes on MRI (Gd-volume) and tumor volumes in (18)F-FET PET images with a tumor-to-brain ratio greater than 1.6 (T(vol 1.6)) were calculated using threshold-based volume-of-interest analyses. The patients were grouped into responders and nonresponders according to the changes of these parameters at different cutoffs, and the influence on progression-free survival and overall survival was tested using univariate and multivariate survival analyses and by receiver-operating-characteristic analyses. RESULTS Early after completion of RCX, a decrease of both TBR(max) and TBR(mean) was a highly significant and independent statistical predictor for progression-free survival and overall survival. Receiver-operating-characteristic analysis showed that a decrease of the TBR(max) between FET-1 and FET-2 of more than 20% predicted favorable survival [corrected], with a sensitivity of 83% and a specificity of 67% (area under the curve, 0.75). Six to eight weeks later, the predictive value of TBR(max) and TBR(mean) was less significant, but an association between a decrease of T(vol 1.6) and PFS was noted. In contrast, Gd-volume changes had no significant predictive value for survival. CONCLUSION In contrast to Gd-volumes on MRI, changes in (18)F-FET PET may be a valuable parameter to assess treatment response in glioblastoma and to predict survival time.
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Affiliation(s)
- Norbert Galldiks
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany.
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