News | January 11, 2013

Radiopharmaceuticals Used to More Accurately Manage Treatment, Predict Survival for Patients with Gliomas

brain tumor

Dec. 3, 2012 – In the management of gliomas — or tumors that originate in the brain — precise assessment of tumor grade and the proliferative activity of cells plays a major role in determining the most appropriate treatment and predicting overall survival. Research published in the December issue of The Journal of Nuclear Medicine (JNM) highlights the potential of imaging with 3'-deoxy-3'-F-18-fluorothymidine (F-18-FLT) positron emission tomography (PET) to noninvasively and accurately provide tumor-specific details to guide management of patients with gliomas.

Gliomas are uncommon neoplasms, and most are diffuse tumors that grow quickly. Patients with glioblastoma, the most malignant and most frequent type of glioma, typically die within two years. Ensuring the most appropriate treatment in a timely manner is of utmost importance for these patients.

Two studies in the December issue of JNM explore the utility of F-18-FLT PET for providing prognostic information for patients with gliomas. “The accumulation of F-18-FLT is dependent on the presence of thymidine kinase-1, which is closely associated with cellular proliferation. In several clinical studies, F-18-FLT has been validated for evaluation of tumor grade and cellular proliferation in gliomas,” noted Yuka Yamamoto, M.D., lead author of the study, “Correlation of 18F-FLT Uptake with Tumor Grade and Ki-67 Immunohistochemistry in Patients with Newly Diagnosed and Recurrent Gliomas.”

In the study led by Yamamoto, researchers retrospectively evaluated F-18-FLT uptake in patients with newly diagnosed (36 patients) and recurrent (20 patients) gliomas. Patients underwent F-18-FLT PET scans; tissue specimens were then taken to obtain a pathological diagnosis. The F-18-FLT images were analyzed by two nuclear medicine physicians, who identified tumor lesions as areas of focally increased uptake exceeding that of normal brain background, and who determined the tumor-to-normal (T/N) ratio. Results the 18-F-FLT PET scan were compared with tumor grade and proliferative activity estimated from the tissue specimens.

Researchers found that there was significant difference in the T/N ratio among different grades of newly diagnosed and recurrent gliomas. F-18-FLT uptake correlated more strongly with the proliferative activity in newly diagnosed gliomas than in recurrent gliomas and provided a more comprehensive view to determine tumor grade as compared to a single tissue specimen.

The correlation between proliferative volume and prediction of overall survival for high-grade glioma patients was also examined in the article “3'-Deoxy-3'-18F-Fluorothymidine PET-Derived Proliferative Volume Predicts Overall Survival in High-Grade Glioma Patients.” In the study, 26 consecutive patients underwent preoperative 18-F-FLT PET/computed tomography (CT) scans. The maximum standardized uptake value (SUVmax) was calculated and three different PET segmentation methods were used to estimate the proliferative volume. The prognostic value of the SUVmax and the different methods to approximate proliferative volume for overall survival were then assessed.

The mean overall survival for the patients in the study was 397 days; 19 patients died during this time. Based on this follow-up information, researchers determined that the signal-to-background ration (SBR) for an adaptive threshold delineation (PVSBR) method showed a significantly better association with overall survival then the SUVmax or the other two PET segmentation methods.

“The predictive value of the proliferative volume for the overall survival of patients seems to be independent of the postoperative treatment,” explained Albert J.S. Idema, M.D., lead author of the study. “The importance for patients is the possible utilization of 18-F-FLT PET to select the most appropriate treatment options. The very limited burden that the procedure causes to the patient is a further asset.”

The development of new molecular imaging agents, such as F-18-FLT, which is currently used only for research purposes, has enabled clinical researchers to utilize the agents to assess the characteristics of tumors and their therapeutic response. “We hope that these findings will be helpful for identifying the role of F-18-FLT in assessing the response to antiproliferative treatment in patients with gliomas,” said Yamamoto.

Authors of the article “3'-Deoxy-3'-18F-Fluorothymidine PET-Derived Proliferative Volume Predicts Overall Survival in High-Grade Glioma Patients” include Albert J.S. Idema, Hieronymus D. Boogaarts and J. Andre Grotenhuis, Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Aswin L. Hoffmann and Esther G.C. Troost, Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, and Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Pieter Wesseling, Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, and Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Arend Heerschap, Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Winette T.A. van der Graaf, Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and Wim J.G. Oyen, Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Authors of the article “Correlation of 18F-FLT Uptake with Tumor Grade and Ki-67 Immunohistochemistry in Patients with Newly Diagnosed and Recurrent Gliomas”include Yuka Yamamoto, Yuko Ono, Fumitoshi Aga, and Yoshihiro Nishiyama, Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan; Nobuyuki Kawai, Department of Neurosurgery, Faculty of Medicine, Kagawa University, Kagawa, Japan; and Nobuyuki Kudomi, Department of Medical Physics, Faculty of Medicine, Kagawa University, Kagawa, Japan.

For more information: http://jnm.snmjournals.org

 

Related Content

ASNC and SNMMI Release Joint Document on Diagnosis, Treatment of Cardiac Sarcoidosis
News | Cardiac Imaging | August 18, 2017
August 18, 2017 — The American Society of Nuclear Cardiology (ASNC) has released a joint expert consensus document wi
Houston Methodist Hospital Enters Multi-Year Technology and Research Agreement With Siemens Healthineers
News | Imaging | August 17, 2017
Houston Methodist Hospital and Siemens Healthineers have entered into a multi-year agreement to bring cutting-edge...
Study Demonstrates First Human Application of Novel PET Tracer for Prostate Cancer

Transaxial 11Csarcosine hybrid PET/CT showed a (triangulated) adenocarcinoma in the transition zone of the anterior right prostate gland on PET (A), CT (B), and a separately obtained T2?weighted MR sequence (C) with resulting PET/MRI registration (D). Image courtesy of M. Piert et al., University of Michigan, Ann Arbor, Mich.

News | Radiopharmaceuticals and Tracers | August 16, 2017
In the featured translational article in the August issue of The Journal of Nuclear Medicine, researchers at the...
MRI Reveals Striking Brain Differences in People with Genetic Autism

Example images for a control participant , a deletion carrier, and a duplication carrier. In the sagittal image of the deletion carrier, the thick corpus callosum, dens and craniocervical abnormality, and cerebellar ectopia are shown. For the duplication carrier, the sagittal image shows the thin corpus callosum and the axial image shows the increased ventricle size and decreased white matter volume. Image courtesy of the Radiological Society of North America (RSNA).

News | Neuro Imaging | August 09, 2017
August 9, 2017 — In the first major study of its kind, researchers using magnetic...
Clinical Data Supports Use of Xoft System for Endometrial Cancer
News | Brachytherapy Systems | August 03, 2017
Researchers presented clinical data supporting use of the Xoft Axxent Electronic Brachytherapy (eBx) System for the...
brain with chronic traumatic injury
News | Magnetic Resonance Imaging (MRI) | August 02, 2017
Fighters are exposed to repeated mild traumatic brain injury (mTBI), which has been associated with neurodegenerative...
NIH-funded scientists have discovered that Parkinson’s disease increases the amount of “free” water in a particular brain area

NIH-funded scientists have discovered that Parkinson’s disease increases the amount of “free” water in a particular brain area. Image courtesy of David Vaillancourt, Ph.D., University of Florida.

News | Neuro Imaging | July 31, 2017
Scientists at the University of Florida have discovered a new method of observing the brain changes caused by Parkinson...
more healthcare providers and patients are choosing options such as Gamma Knife stereotactic radiosurgery
News | Radiation Therapy | July 31, 2017
Each year, up to 650,000 people who were previously diagnosed with various forms of cancer will develop brain...
"Residual Echo" of Ancient Humans May Hold Clues to Mental Disorders

MRI data shows (left) areas of the skull preferentially affected by the amount of Neanderthal-derived DNA and (right) areas of the brain’s visual system in which Neanderthal gene variants influenced cortex folding (red) and gray matter volume (yellow). Image courtesy of Michael Gregory, M.D., NIMH Section on Integrative Neuroimaging

News | Neuro Imaging | July 26, 2017
Researchers from the National Institute of Mental Health (NIMH) have produced the first direct evidence that parts of...
Overlay Init