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Radiation Oncology
Published in: Radiation Oncology 1/2016

Open Access 01-12-2016 | Research

Suspected recurrence of brain metastases after focused high dose radiotherapy: can [18F]FET- PET overcome diagnostic uncertainties?

Authors: Alexander Romagna, Marcus Unterrainer, Christine Schmid-Tannwald, Matthias Brendel, Jörg-Christian Tonn, Silke Birgit Nachbichler, Alexander Muacevic, Peter Bartenstein, Friedrich-Wilhelm Kreth, Nathalie Lisa Albert

Published in: Radiation Oncology | Issue 1/2016

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Abstract

Background

After focused high dose radiotherapy of brain metastases, differentiation between tumor recurrence and radiation-induced lesions by conventional MRI is challenging. This study investigates the usefulness of dynamic O-(2-18F-Fluoroethyl)-L-Tyrosine positron emission tomography (18F-FET PET) in patients with MRI-based suspicion of tumor recurrence after focused high dose radiotherapy of brain metastases.

Methods

Twenty-two patients with 34 brain metastases (median age 61.9 years) were included. Due to follow-up scan evaluations after repeated treatment in a subset of patients, a total of 50 lesions with MRI-based suspicion of tumor recurrence after focused high dose radiotherapy could be evaluated. 18F-FET PET analysis included the assessment of maximum and mean tumor-to-background ratio (TBRmax and TBRmean) and analysis of time-activity-curves (TAC; increasing vs. decreasing) including minimal time-to-peak (TTPmin). PET parameters were correlated with histological findings and radiological-clinical follow-up evaluation.

Results

Tumor recurrence was found in 21/50 cases (15/21 verified by histology, 6/21 by radiological-clinical follow-up) and radiation-induced changes in 29/50 cases (5/29 verified by histology, 24/29 by radiological-clinical follow-up). Median clinical-radiological follow-up was 28.3 months (range 4.2–99.1 months). 18F-FET uptake was higher in tumor recurrence compared to radiation-induced changes (TBRmax 2.9 vs. 2.0, p < 0.001; TBRmean 2.2 vs. 1.7, p < 0.001). Receiver-operating-characteristic (ROC) curve analysis revealed optimal cut-off values of 2.15 for TBRmax and 1.95 for TBRmean (sensitivity 86 %, specificity 79 %). Increasing TACs and long TTPmin were associated with radiation-induced changes, decreasing TACs with tumor recurrence (p = 0.01). By combination of TBR and TACs, sensitivity and specificity could be increased to 93 and 84 %.

Conclusions

In patients with MRI-suspected tumor recurrence after focused high dose radiotherapy, 18F-FET PET has a high sensitivity and specificity for the differentiation of vital tumor tissue and radiation-induced lesions.
Literature
1.
Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA. 2006;295:2483–91.CrossRefPubMed
2.
Schüttrumpf LH, Niyazi M, Nachbichler SB, et al. Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1–3 cerebral metastases. Radiat Oncol. 2014;9:105.CrossRefPubMedPubMedCentral
3.
Ruge MI, Kickingereder P, Grau S, Hoevels M, Treuer H, Sturm V. Stereotactic biopsy combined with stereotactic (125)iodine brachytherapy for diagnosis and treatment of locally recurrent single brain metastases. J Neurooncol. 2011;105:109–18.CrossRefPubMed
4.
Szeifert GT, Atteberry DS, Kondziolka D, Levivier M, Lunsford LD. Cerebral metastases pathology after radiosurgery: a multicenter study. Cancer. 2006;106:2672–81.CrossRefPubMed
5.
Ross DA, Sandler HM, Balter JM, Hayman JA, Archer PG, Auer DL. Imaging changes after stereotactic radiosurgery of primary and secondary malignant brain tumors. J Neurooncol. 2002;56:175–81.CrossRefPubMed
6.
Jansen NL, Suchorska B, Schwarz SB, et al. [18F]fluoroethyltyrosine-positron emission tomography-based therapy monitoring after stereotactic iodine-125 brachytherapy in patients with recurrent high-grade glioma. Mol Imaging. 2013;12:137–47.PubMed
7.
Minniti G, Scaringi C, Paolini S, et al. Repeated stereotactic radiosurgery for patients with progressive brain metastases. J Neurooncol. 2016;126:91–7.CrossRefPubMed
8.
Dooms GC, Hecht S, Brant-Zawadzki M, et al. Brain radiation lesions: MR imaging. Radiology. 1986;158:149–55.CrossRefPubMed
9.
Horky LL, Hsiao EM, Weiss SE, Drappatz J, Gerbaudo VH. Dual phase FDG-PET imaging of brain metastases provides superior assessment of recurrence versus post-treatment necrosis. J Neurooncol. 2011;103:137–46.CrossRefPubMed
10.
Galldiks N, Stoffels G, Filss CP, et al. Role of O-(2-(18)F-fluoroethyl)-L-tyrosine PET for differentiation of local recurrent brain metastasis from radiation necrosis. J Nucl Med. 2012;53:1367–74.CrossRefPubMed
11.
Tsuyuguchi N, Sunada I, Iwai Y, et al. Methionine positron emission tomography of recurrent metastatic brain tumor and radiation necrosis after stereotactic radiosurgery: is a differential diagnosis possible? J Neurosurg. 2003;98:1056–64.CrossRefPubMed
12.
Galldiks N, Langen KJ, Pope WB. From the clinician’s point of view - What is the status quo of positron emission tomography in patients with brain tumors? Neuro Oncol. 2015;17:1434–44.CrossRefPubMed
13.
Suchorska B, Jansen NL, Linn J, et al. Biological tumor volume in 18FET-PET before radiochemotherapy correlates with survival in GBM. Neurology. 2015;847:710–9.CrossRef
14.
Suchorska B, Albert NL, Tonn JC. Usefulness of PET imaging to guide treatment options in gliomas. Curr Treat Options Neurol. 2016;18:4.CrossRefPubMed
15.
Grosu AL, Astner ST, Riedel E, et al. An interindividual comparison of O-(2-[18F]fluoroethyl)-L-tyrosine (FET)- and L-[methyl-11C]methionine (MET)-PET in patients with brain gliomas and metastases. Int J Radiat Oncol Biol Phys. 2011;81:1049–58.CrossRefPubMed
16.
Macdonald DR, Cascino TL, Schold SC, et al. Response criteria for phase II studies of malignant glioma. J Clin Oncol. 1990;8:1277–80.PubMed
17.
Schwartz C, Romagna A, Thon N, et al. Outcome and toxicity profile of salvage low-dose-rate iodine-125 stereotactic brachytherapy in recurrent high-grade gliomas. Acta Neurochir. 2015;157:1757–64.CrossRefPubMed
18.
Thon N, Eigenbrod S, Grasbon-Frodl EM, et al. Novel molecular stereotactic biopsy procedures reveal intratumoral homogeneity of loss of heterozygosity of 1p/19q and TP53 mutations in World Health Organization grade II gliomas. J Neuropathol Exp Neurol. 2009;68:1219–28.CrossRefPubMed
19.
Jansen NL, Schwartz C, Graute V, et al. Prediction of oligodendroglial histology and LOH 1p/19q using dynamic [(18)F]FET-PET imaging in intracranial WHO grade II and III gliomas. Neuro Oncol. 2012;14:1473–80.CrossRefPubMedPubMedCentral
20.
Jansen NL, Suchorska B, Wenter V, et al. Prognostic significance of dynamic 18F-FET PET in newly diagnosed astrocytic high-grade glioma. J Nucl Med. 2015;56:9–15.CrossRefPubMed
21.
Thon N, Kunz M, Lemke L, et al. Dynamic 18F-FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses. Int J Cancer. 2015;136:2132–45.CrossRefPubMed
22.
Lizarraga KJ, Allen-Auerbach M, Czernin J, et al. (18)F-FDOPA PET for differentiating recurrent or progressive brain metastatic tumors from late or delayed radiation injury after radiation treatment. J Nucl Med. 2014;55:30–6.CrossRefPubMed
23.
Cicone F, Minniti G, Romano A, et al. Accuracy of F-DOPA PET and perfusion-MRI for differentiating radionecrotic from progressive brain metastases after radiosurgery. Eur J Nucl Med Mol Imaging. 2015;42:103–11.CrossRefPubMed
24.
Filss C, Jansen N, Böning G, et al. Methodenvergleich der FET PET von Hirntumoren in zwei großen Zentren. Hannover: Kongress der Deutschen Gesellschaft für Nuklearmedizin; 2015. p. 53. Conference paper, abstract nr. V36.
Metadata
Title
Suspected recurrence of brain metastases after focused high dose radiotherapy: can [18F]FET- PET overcome diagnostic uncertainties?
Authors
Alexander Romagna
Marcus Unterrainer
Christine Schmid-Tannwald
Matthias Brendel
Jörg-Christian Tonn
Silke Birgit Nachbichler
Alexander Muacevic
Peter Bartenstein
Friedrich-Wilhelm Kreth
Nathalie Lisa Albert
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2016
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-016-0713-8

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