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Cobes N, Tran S, Mathon B, Nichelli L, Bielle F, Touat M, Kas A, Rozenblum L. Exploring the mechanism of 18F-fluorodopa uptake in recurrent high-grade gliomas: A comprehensive histomolecular-positron emission tomography analysis. Eur J Neurol 2024; 31:e16093. [PMID: 37823694 PMCID: PMC11236017 DOI: 10.1111/ene.16093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Dihydroxy-6-[18F]fluoro-L-phenylalanine (18F-FDOPA) positron emission tomography (PET) is a valuable tool for managing high-grade gliomas (HGGs), but there is a lack of literature on its relationship with glioma subtypes since the 2021 reclassification of brain tumors. There is also debate surrounding the mechanism of 18F-FDOPA uptake, particularly after chemoradiation therapy. This study aimed to investigate the correlation between 18F-FDOPA uptake and histomolecular characteristics, particularly L-amino acid transporter 1 (LAT1) expression, in recurrent gliomas, and examine their impact on survival in HGGs. METHODS Thirty-nine patients with recurrent HGGs (14 isocitrate dehydrogenase [IDH]-mutant, 25 IDH-wildtype) who underwent a brain 18F-FDOPA PET/computed tomography (CT) or PET/magnetic resonance imaging (MRI) followed by surgical resection of the 18F-FDOPA-avid lesion within 6 months, were retrospectively reviewed. PET results were compared with histological examination and for SCL7A5/LAT1 immunostaining. The study also examined the relationship between PET parameters, LAT1 expression, and survival outcomes. RESULTS Astrocytoma IDH-mutant G4 had higher 18F-FDOPA uptake than glioblastoma IDH-wildtype G4 (maximum tumor-to-normal brain ratio [TBRmax] 5 [3.4-9] vs. 3.8 [2.8-5.9], p = 0.02). IDH-mutant gliomas had higher LAT1 expression than IDH-wildtype gliomas (100 [14-273] vs. 15.5 [0-137], p < 0.05) as well as higher TBRmax (5 [2.4-9] vs. 3.8 [2.8-6], p < 0.05). In survival analysis, LAT1 score >100 was a predictor for longer progression-free survival in IDH-mutant HGGs. CONCLUSIONS To our knowledge, our study is the first to suggest a link between LAT1 expression and IDH mutation status. We showed that higher TBRmax was associated with higher LAT1 expression and IDH mutation status. Further studies are needed to better understand the mechanisms underlying amino acid PET tracers uptake, especially in the post-radiation and chemotherapy settings.
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Affiliation(s)
- Nina Cobes
- Department of Nuclear Medicine, Groupe Hospitalier Pitié‐Salpêtrière, APHPSorbonne UniversitéParisFrance
| | - Suzanne Tran
- Department of Neuropathology, Groupe Hospitalier Pitié‐Salpêtrière, APHPSorbonne UniversitéParisFrance
| | - Bertrand Mathon
- Department of Neurosurgery, Groupe Hospitalier Pitié‐Salpêtrière, APHPSorbonne UniversitéParisFrance
| | - Lucia Nichelli
- Department of Neuroradiology, Groupe Hospitalier Pitié‐Salpêtrière, APHPSorbonne UniversitéParisFrance
| | - Franck Bielle
- Department of Neuropathology, Groupe Hospitalier Pitié‐Salpêtrière, APHPSorbonne UniversitéParisFrance
| | - Mehdi Touat
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP‐HP, Hôpitaux Universitaires La Pitié Salpétrière ‐ Charles Foix, Service de Neurologie 2‐MazarinParisFrance
| | - Aurélie Kas
- Department of Nuclear Medicine, Groupe Hospitalier Pitié‐Salpêtrière, APHPSorbonne UniversitéParisFrance
- LIB, INSERM U1146Sorbonne UniversitéParisFrance
| | - Laura Rozenblum
- Department of Nuclear Medicine, Groupe Hospitalier Pitié‐Salpêtrière, APHPSorbonne UniversitéParisFrance
- LIB, INSERM U1146Sorbonne UniversitéParisFrance
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2
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Castello A, Castellani M, Florimonte L, Ciccariello G, Mansi L, Lopci E. PET radiotracers in glioma: a review of clinical indications and evidence. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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3
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Djekidel M, Alsadi R, Bouhali O, Maaz AUR. Amino Acid PET Imaging with 18F-DOPA in the evaluation of Pediatric Brain Tumors. J Nucl Med Technol 2022; 50:jnmt.121.263050. [PMID: 35440479 DOI: 10.2967/jnmt.121.263050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Although MRI is the workhorse of brain tumor initial evaluation and follow-up, there is a growing amount of data recommending the incorporation of amino-acid PET imaging at different stages of the management of these patients. Recent nuclear medicine and neuro-oncology clinical practice recommendations support the use of amino-acid imaging in brain tumor imaging. Considering 18F-DOPA is FDA approved for the evaluation of parkinsonian syndromes, it could be used clinically for other valuable clinical indications such as brain tumor evaluations. This value seems to be well established in adults and has growing evidence for its use in pediatrics as well. We offer to present four pediatric brain tumor cases imaged with 18F-DOPA and review the literature.
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Affiliation(s)
- Mehdi Djekidel
- Department of Diagnostic Imaging, Division of Nuclear Medicine and Molecular Imaging, Sidra Medicine, Qatar
| | - Rahaf Alsadi
- Department of Science, Texas A&M University at Qatar
| | | | - Ata Ur Rehman Maaz
- Department of Pediatrics, Division of Hematology Oncology, Sidra Medicine, Qatar
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4
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Ninatti G, Sollini M, Bono B, Gozzi N, Fedorov D, Antunovic L, Gelardi F, Navarria P, Politi LS, Pessina F, Chiti A. Preoperative [11C]methionine PET to personalize treatment decisions in patients with lower-grade gliomas. Neuro Oncol 2022; 24:1546-1556. [PMID: 35171292 PMCID: PMC9435504 DOI: 10.1093/neuonc/noac040] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND PET with radiolabelled amino acids is used in the preoperative evaluation of patients with glial neoplasms. This study aimed to assess the role of [ 11C]methionine (MET) PET in assessing molecular features, tumour extent, and prognosis in newly-diagnosed lower-grade gliomas (LGGs) surgically treated. METHODS 153 patients with a new diagnosis of grade 2/3 glioma who underwent surgery at our Institution and were imaged preoperatively using [ 11C]MET PET/CT were retrospectively included. [ 11C]MET PET images were qualitatively and semiquantitatively analyzed using tumour-to-background ratio (TBR). Progression-free survival (PFS) rates were estimated using the Kaplan-Meier method and Cox proportional-hazards regression was used to test the association of clinicopathological and imaging data to PFS. RESULTS Overall, 111 lesions (73%) were positive, while thirty-two (21%) and ten (6%) were isometabolic and hypometabolic at [ 11C]MET PET, respectively. [ 11C]MET uptake was more common in oligodendrogliomas than IDH-mutant astrocytomas (87% vs 50% of cases, respectively). Among [ 11C]MET-positive gliomas, grade 3 oligodendrogliomas had the highest median TBRmax (3.22). In 25% of patients, PET helped to better delineate tumour margins compared to MRI only. In IDH-mutant astrocytomas, higher TBRmax values at [ 11C]MET PET were independent predictors of shorter PFS. CONCLUSIONS This work highlights the role of preoperative [ 11C]MET PET in estimating the type, assessing tumour extent, and predicting biological behaviour and prognosis of LGGs. Our findings support the implementation of [ 11C]MET PET in routine clinical practice to better manage these neoplasms.
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Affiliation(s)
- Gaia Ninatti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele - Milan, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele - Milan, Italy.,Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano - Milan, Italy
| | - Beatrice Bono
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele - Milan, Italy.,Neurosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano - Milan, Italy
| | - Noemi Gozzi
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano - Milan, Italy
| | - Daniil Fedorov
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele - Milan, Italy
| | - Lidija Antunovic
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano - Milan, Italy
| | - Fabrizia Gelardi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele - Milan, Italy.,Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano - Milan, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele - Milan, Italy.,Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano - Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele - Milan, Italy.,Neurosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano - Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele - Milan, Italy.,Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni, Rozzano - Milan, Italy
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5
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Moon H, Byun BH, Lim I, Kim BI, Choi CW, Rhee CH, Lee KC, Woo SK, Park C, Kil HS, Chi DY, Youn SM, Lim SM. A Phase 0 Microdosing PET/CT Study Using O-[18F]Fluoromethyl-d-Tyrosine in Normal Human Brain and Brain Tumor. Clin Nucl Med 2021; 46:717-722. [PMID: 34034333 DOI: 10.1097/rlu.0000000000003735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the present study was to obtain information about distribution, radiation dosimetry, toxicity, and pharmacokinetics of O-[18F]fluoromethyl-d-tyrosine (d-18F-FMT), an amino acid PET tracer, in patients with brain tumors. PATIENTS AND METHODS A total of 6 healthy controls (age = 19-25 years, 3 males and 3 females) with brain PET images and radiation dosimetry and 12 patients (median age = 60 years, 6 males and 6 females) with primary (n = 5) or metastatic brain tumor (n = 7) were enrolled. We acquired 60-minute dynamic brain PET images after injecting 370 MBq of d-18F-FMT. Time-activity curves of d-18F-FMT uptake in normal brain versus brain tumors and tumor-to-background ratio were analyzed for each PET data set. RESULTS Normal cerebral uptake of d-18F-FMT decreased from 0 to 5 minutes after injection, but gradually increased from 10 to 60 minutes. Tumoral uptake of d-18F-FMT reached a peak before 30 minutes. Tumor-to-background ratio peaked at less than 15 minutes for 8 patients and more than 15 minutes for 4 patients. The mean effective dose was calculated to be 13.2 μSv/MBq. CONCLUSIONS Using d-18F-FMT as a PET radiotracer is safe. It can distinguish brain tumor from surrounding normal brain tissues with a high contrast. Early-time PET images of brain tumors should be acquired because the tumor-to-background ratio tended to reach a peak within 15 minutes after injection.
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Affiliation(s)
| | | | | | | | | | | | - Kyo Chul Lee
- Division of RI Convergence, Korea Institute of Radiological and Medical Sciences
| | - Sang-Keun Woo
- Division of RI Convergence, Korea Institute of Radiological and Medical Sciences
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Chiaravalloti A, Ricci M, Cimini A, Russo F, Ursini F, Filippi L, Schillaci O. 18F-FDOPA PET/CT SUV-Derived Indices and Volumetric Parameters Correlation in Patients with Primary Brain Tumors. Cancers (Basel) 2021; 13:cancers13174315. [PMID: 34503123 PMCID: PMC8431205 DOI: 10.3390/cancers13174315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary This paper aims to improve the knowledge regarding 18F-FDOPA PET/CT parameters that may influence both the interpretation of PET data and the management of primary brain tumors. The evaluation of volumetric parameters in 18F-FDOPA imaging is uncommon, and we aim to increase the scientific interest on the potential role of volumetric parameters in the clinical practice. The standardized uptake value (SUV)-derived indices as SUV max, SUV mean, SUV max ratio, and SUV mean ratio are widely used but the exact methodology to elaborate SUV ratio is not well established. Therefore, this study aims to assess the correlation between SUV-derived indices and volumetric uptake parameters. Abstract Novel parameters in PET imaging, such as volumetric parameters, are gaining interest in the scientific literature, but the role of dopaminergic tumor volume (DTV) and total lesion F-DOPA activity (TLDA) and the correlation between volumetric and SUV-derived parameters are not well defined yet. One hundred and thirty-three patients that underwent 18F-FDOPA imaging for primary brain tumors were included in this retrospective study. SUV-derived indices were calculated (the occipital region was chosen to generate ratios of tumor SUV) and compared with volumetric parameters. Regression models were applied in univariate analysis and lnSUVmax was positively associated with lnDTV (beta 0.42, p = 0.007), the lnSUVmax ratio was positively associated with lnDTV (beta 0.80, p = 0.011), lnSUVmax was positively associated with lnTLDA (beta 1.27, p < 0.0001), and the lnSUVmax ratio was positively associated with lnTLDA (beta 1.87, p < 0.0001). Our study demonstrates that volumetric uptake parameters in 18F-FDOPA PET/CT are easier to assess in primary brain tumors with higher SUV max and SUV max ratios, and supports the emerging role of volumetric parameters in the data interpretation.
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Affiliation(s)
- Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (A.C.); (A.C.); (O.S.)
- Nuclear Medicine Section, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Maria Ricci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (A.C.); (A.C.); (O.S.)
- Correspondence:
| | - Andrea Cimini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (A.C.); (A.C.); (O.S.)
| | - Francesca Russo
- UOC Nuclear Medicine, Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Francesco Ursini
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40127 Bologna, Italy
| | - Luca Filippi
- UOC Nuclear Medicine, Santa Maria Goretti Hospital, 04100 Latina, Italy;
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (A.C.); (A.C.); (O.S.)
- Nuclear Medicine Section, IRCCS Neuromed, 86077 Pozzilli, Italy
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7
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MGMT Promoter Methylation and IDH1 Mutations Do Not Affect [ 18F]FDOPA Uptake in Primary Brain Tumors. Int J Mol Sci 2020; 21:ijms21207598. [PMID: 33066633 PMCID: PMC7589068 DOI: 10.3390/ijms21207598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/10/2023] Open
Abstract
The aim of our study was to investigate the effects of methylation of O⁶-methylguanine-DNA methyltransferase promoter (MGMTp) and isocitrate dehydrogenase 1 (IDH 1) mutations on amino acid metabolism evaluated with 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine ([18F] FDOPA) positron emission tomography/computed tomography (PET/CT). Seventy-two patients with primary brain tumors were enrolled in the study (33 women and 39 men; mean age 44 ± 12 years old). All of them were subjected to PET/CT examination after surgical treatment. Of them, 29 (40.3%) were affected by grade II glioma and 43 (59.7%) by grade III. PET/CT was scored as positive or negative and standardized uptake value ratio (SUVr) was calculated as the ratio between SUVmax of the lesion vs. that of the background. Statistical analysis was performed with the Mann–Whitney U test. Methylation of MGMTp was detectable in 61 out of the 72 patients examinated. Mean SUVr in patients without methylation of MGMTp was 1.44 ± 0.38 vs. 1.35 ± 0.48 of patients with methylation (p = 0.15). Data on IDH1 mutations were available for 43 subjects; of them, 31 are IDH-mutant. Mean SUVr was 1.38 ± 0.51 in patients IDH mutant and 1.46 ± 0.56 in patients IDH wild type. MGMTp methylation and IDH1 mutations do not affect [18F] FDOPA uptake in primary brain tumors and therefore cannot be assessed or predicted by radiopharmaceutical uptake parameters.
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Somme F, Bender L, Namer IJ, Noël G, Bund C. Usefulness of 18F-FDOPA PET for the management of primary brain tumors: a systematic review of the literature. Cancer Imaging 2020; 20:70. [PMID: 33023662 PMCID: PMC7541204 DOI: 10.1186/s40644-020-00348-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 09/21/2020] [Indexed: 11/30/2022] Open
Abstract
Contrast-enhanced magnetic resonance imaging is currently the standard of care in the management of primary brain tumors, although certain limitations remain. Metabolic imaging has proven useful for an increasing number of indications in oncology over the past few years, most particularly 18F-FDG PET/CT. In neuro-oncology, 18F-FDG was insufficient to clearly evaluate brain tumors. Amino-acid radiotracers such as 18F-FDOPA were then evaluated in the management of brain diseases, notably tumoral diseases. Even though European guidelines on the use of amino-acid PET in gliomas have been published, it is crucial that future studies standardize acquisition and interpretation parameters. The aim of this article was to systematically review the potential effect of this metabolic imaging technique in numerous steps of the disease: primary and recurrence diagnosis, grading, local and systemic treatment assessment, and prognosis. A total of 41 articles were included and analyzed in this review. It appears that 18F-FDOPA PET holds promise as an effective additional tool in the management of gliomas. More consistent prospective studies are still needed.
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Affiliation(s)
- François Somme
- Nuclear medicine Department, Hautepierre University Hospital, 1, rue Molière, F-67000, Strasbourg, France.
| | - Laura Bender
- Oncology Department, Hautepierre University Hospital, 1, rue Molière, F-67000, Strasbourg, France
| | - Izzie Jacques Namer
- Nuclear medicine Department, Hautepierre University Hospital, 1, rue Molière, F-67000, Strasbourg, France
- Strasbourg University, Unistra/CNRS UMR 7237, Strasbourg, France
| | - Georges Noël
- Radiotherapy Department, Paul Strauss Comprehensive Cancer Center, 3, rue de la porte de l'hôpital, F-67065, Strasbourg, France
- Strasbourg University, CNRS, IPHC UMR 7178, Centre Paul Strauss, UNICANCER, F-67000, Strasbourg, France
| | - Caroline Bund
- Nuclear medicine Department, Hautepierre University Hospital, 1, rue Molière, F-67000, Strasbourg, France
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Abstract
OBJECTIVE. Diagnosing brain tumor recurrence, especially with changes that occur after treatment, is a challenge. MRI has an exceptional structural resolution, which is important from the perspective of treatment planning. However, its reliability in diagnosing recurrence is relatively lower, when compared to metabolic imaging. The latter is more sensitive to the early changes associated with recurrence and relatively immune to confounding by treatment related changes. CONCLUSION. There is no one-stop shop for the diagnosis of recurrence in brain tumors. The sensitivity of metabolic imaging is not a substitute for the resolution of the MRI, making a multi-modal approach the only way forward.
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Chiaravalloti A, Filippi L, Ricci M, Cimini A, Schillaci O. Molecular Imaging in Pediatric Brain Tumors. Cancers (Basel) 2019; 11:cancers11121853. [PMID: 31771237 PMCID: PMC6966547 DOI: 10.3390/cancers11121853] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023] Open
Abstract
In the last decade, several radiopharmaceuticals have been developed and investigated for imaging in vivo of pediatric brain tumors with the aim of exploring peculiar metabolic processes as glucose consumption, amino-acid metabolism, and protein synthesis with nuclear medicine techniques. Although the clinical shreds of evidence are limited, preliminary results are encouraging. In this review, we performed web-based and desktop research summarizing the most relevant findings of the literature published to date on this topic. Particular attention was given to the wide spectrum of nuclear medicine advances and trends in pediatric neurooncology and neurosurgery. Furthermore, the role of somatostatin receptor imaging through single-photon emission computed tomography (SPECT) and positron emission tomography (PET) probes, with reference to their potential therapeutic implications, was examined in the peculiar context. Preliminary results show that functional imaging in pediatric brain tumors might lead to significant improvements in terms of diagnostic accuracy and it could be of help in the management of the disease.
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Affiliation(s)
- Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy (O.S.)
- Nuclear Medicine Section, IRCCS Neuromed, 86077 Pozzilli, Italy
- Correspondence: or ; Tel.: +39-062-090-2457
| | - Luca Filippi
- Nuclear Medicine Section, “Santa Maria Goretti” Hospital, 04100 Latina, Italy;
| | - Maria Ricci
- Department of Radiological, Oncological and Pathological Sciences, Faculty of Medicine and Surgery, La Sapienza University, 00161 Rome, Italy;
| | - Andrea Cimini
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy (O.S.)
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy (O.S.)
- Nuclear Medicine Section, IRCCS Neuromed, 86077 Pozzilli, Italy
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Baguet T, Verhoeven J, De Vos F, Goethals I. Cost-Effectiveness of [ 18F] Fluoroethyl-L-Tyrosine for Temozolomide Therapy Assessment in Patients With Glioblastoma. Front Oncol 2019; 9:814. [PMID: 31555584 PMCID: PMC6722181 DOI: 10.3389/fonc.2019.00814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/08/2019] [Indexed: 01/10/2023] Open
Abstract
Background and Purpose: Glioblastomas are the most aggressive of all gliomas. The prognosis of these gliomas, which are classified as grade IV tumors by the World Health Organization (WHO), is poor. Combination therapy, including surgery, radiotherapy, and chemotherapy has variable outcomes and is expensive. In light of rising healthcare costs, there are societal demands for the justification of medical expenses. Therefore, we calculated the cost-effectiveness of follow-up [18F] fluoroethyl-L-tyrosine ([18F] FET) positron emission tomography (PET) scans performed on patients with glioblastoma after surgery and before commencing temozolomide maintenance treatment. Materials and Methods: To determine the cost-effectiveness of follow-up [18F] FET PET procedures, we examined published clinical data and calculated the associated costs in the context of Belgian healthcare. We subsequently performed one-way deterministic sensitivity analysis and Monte Carlo analysis on the calculated ratios. Results: The decision tree based on overall survival rates showed that the number of non-responders identified using PET was 57.14% higher than the number of non-responders identified using conventional MRI. Further, the decision tree based on progression-free survival rates revealed a comparable increase of 57.50% non-responders identified. The calculated cost of two required PET scans per patient during the follow-up treatment phase was 780.50 euros. Two cost-effectiveness ratios were determined for overall survival and progression-free survival rates. Both of these calculations yielded very similar results: incremental cost-effectiveness ratios of 1,365.86 and 1,357.38 euros, respectively, for each identified non-responder. The findings of the sensitivity analysis supported the calculated results, confirming that the obtained data were robust. Conclusion: Our comparative study of conventional MRI and [18F] FET PET revealed that the latter is a valuable tool for predicting the treatment responses of patients with glioblastomas to follow-up temozolomide maintenance treatment while considering its cost-effectiveness. Thus, [18F] FET PET scans enable clinical outcomes to be predicted accurately and at a low cost. Moreover, given the robustness of the data in the sensitivity analyses, the level of certainty of this outcome is acceptable.
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Affiliation(s)
- Tristan Baguet
- Laboratory of Radiopharmacy, Ghent University, Ghent, Belgium
| | | | - Filip De Vos
- Laboratory of Radiopharmacy, Ghent University, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, University Hospital Ghent, Ghent, Belgium
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