18F-FCho PET and MRI for the prediction of response in glioblastoma patients according to the RANO criteria

Bolcaen, Julie; Acou, Marjan; Boterberg, Tom; Vanhove, Christian; Vos, Filip De; Broecke, Caroline Van den; Holen, Roel Van; Deblaere, Karel; Goethals, Ingeborg

doi:10.1097/mnm.0000000000000638

Cited by 22 publications

(28 citation statements)

References 34 publications

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“…in our study, 8 cases out of 12 (66.7%) showed clinical decline that was corresponding to recurrent solid lesions while the other 4 patients (33.3%) showed good clinical status either stable or even improved (50:50%). This is matching with another study, which reported a clinical decline due to progressive course in 63.6 percent of their patients (11) .…”

Section: Discussionsupporting

confidence: 90%

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Practical Needs in Assessing Response to Therapy in Operated Brain High Grade Glioma According to Response Assessment in Neuro-Oncology Criteria

Almolla¹,

Tantawy²,

Mahmoud³

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Tumors known as gliomas begin in the brain or spine's glial cells and might spread throughout the body. An effort was made to improve tumor response evaluation and end point selection through the Response Assessment in Neuro-Oncology (RANO) working group. Objective: To standardize the assessment method and results reporting by applying MRI-RANO criteria in detecting glioma response to surgical treatment. Patients and Methods: This was a prospective cohort study included 12 patients (4 males and 8 females) whose mean age was 53.6 ± 15.1years. Included patients are those who were operated and pathologically proved as brain glioma grade IV (GBM). They underwent post-operative MRI within 48 hours and are available for follow up MRI after 3 months. Imaging modalities applied in both MRI exams were conventional magnetic resonance imaging, MRI diffusion weighted images, and contrast imaging. RANO criteria were applied. Results: According to RANO criteria, none of the lesions had pseudo response or pseudo progression. However, two thirds (66.7%) had progressive disease and one third (33.3%) had complete response. There was statistically significant association between MRI findings 3 months postoperative and RANO criteria as patients with compete response had statistically significant decrease on measurable solid components, diffusion restriction, post contrast enhancement and all lesions had grade I edema with no mass effect or midline shift compared to patients with progressive disease. 4 cases that showed complete response category had fulfilled all the RANO criteria, while 8 cases with category progressive disease had fulfilled more than one of the described RANO criteria. Conclusion: RANO criteria are an effective tool to be used in interpretation of MRI for follow-up of surgically operated glioma patients to detect their response.

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Section: Discussionsupporting

confidence: 90%

“…A study evaluated 13 patients found that 4 cases showed complete response to treatment (30.7%) (13) . Another one reported 7 cases (63.6%) out of 11 patients included in their study showed progressive course as we noticed (11) . These studies included nearly the same numbers of the patients in our study, which intensify our results.…”

Section: Discussionmentioning

confidence: 50%

Practical Needs in Assessing Response to Therapy in Operated Brain High Grade Glioma According to Response Assessment in Neuro-Oncology Criteria

Almolla¹,

Tantawy²,

Mahmoud³

et al. 2021

The Egyptian Journal of Hospital Medicine

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“…PET radiopharmaceutical choline analogues are considered successful as oncological PET probes because a major hallmark of cancer cells is increased lipogenesis. In the brain, discrimination between tumor and normal tissue is feasible because of lower physiological uptake of [ 11 C]choline ([ 11 C]Cho) or [ 18 F]fluoroethyl-choline ([ 18 F]FCho) by normal brain cells [30,31]. The performance of [ 18 F]FCho-PET may distinguish high-grade glioma, brain metastases and benign lesions in addition to its importance for surgery management (including identifying the most malignant areas for stereotactic sampling) [32][33][34][35].…”

Section: Established and Emerging Pet/spect Radiopharmaceuticals In N...mentioning

confidence: 99%

A perspective on the radiopharmaceutical requirements for imaging and therapy of glioblastoma

Bolcaen¹,

Kleynhans²,

Nair³

et al. 2021

Theranostics

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Despite numerous clinical trials and pre-clinical developments, the treatment of glioblastoma (GB) remains a challenge. The current survival rate of GB averages one year, even with an optimal standard of care. However, the future promises efficient patient-tailored treatments, including targeted radionuclide therapy (TRT). Advances in radiopharmaceutical development have unlocked the possibility to assess disease at the molecular level allowing individual diagnosis. This leads to the possibility of choosing a tailored, targeted approach for therapeutic modalities. Therapeutic modalities based on radiopharmaceuticals are an exciting development with great potential to promote a personalised approach to medicine. However, an effective targeted radionuclide therapy (TRT) for the treatment of GB entails caveats and requisites. This review provides an overview of existing nuclear imaging and TRT strategies for GB. A critical discussion of the optimal characteristics for new GB targeting therapeutic radiopharmaceuticals and clinical indications are provided. Considerations for target selection are discussed, i.e. specific presence of the target, expression level and pharmacological access to the target, with particular attention to blood-brain barrier crossing. An overview of the most promising radionuclides is given along with a validation of the relevant radiopharmaceuticals and theranostic agents (based on small molecules, peptides and monoclonal antibodies). Moreover, toxicity issues and safety pharmacology aspects will be presented, both in general and for the brain in particular.

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“…18 F-fluorocholine is a widely available PET tracer that is a small precursor molecule for the synthesis of membrane phospholipids. 18 F-fluorocholine PET can predict early response in glioblastoma treated with radiotherapy and temozolomide [104]. Clinical value in ICMs has not been evaluated.…”

Section: Limitations Of Conventional Non-immune-specific Pet Biomarkersmentioning

confidence: 99%

Imaging-guided precision medicine in glioblastoma patients treated with immune checkpoint modulators: research trend and future directions in the field of imaging biomarkers and artificial intelligence

et al. 2019

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Immunotherapies that employ immune checkpoint modulators (ICMs) have emerged as an effective treatment for a variety of solid cancers, as well as a paradigm shift in the treatment of cancers. Despite this breakthrough, the median survival time of glioblastoma patients has remained at about 2 years. Therefore, the safety and anti-cancer efficacy of combination therapies that include ICMs are being actively investigated. Because of the distinct mechanisms of ICMs, which restore the immune system’s anti-tumor capacity, unconventional immune-related phenomena are increasingly being reported in terms of tumor response and progression, as well as adverse events. Indeed, immunotherapy response assessments for neuro-oncology (iRANO) play a central role in guiding cancer patient management and define a “wait and see strategy” for patients treated with ICMs in monotherapy with progressive disease on MRI. This article deciphers emerging research trends to ameliorate four challenges unaddressed by the iRANO criteria: (1) patient selection, (2) identification of immune-related phenomena other than pseudoprogression (i.e., hyperprogression, the abscopal effect, immune-related adverse events), (3) response assessment in combination therapies including ICM, and (4) alternatives to MRI. To this end, our article provides a structured approach for standardized selection and reporting of imaging modalities to enable the use of precision medicine by deciphering the characteristics of the tumor and its immune environment. Emerging preclinical or clinical innovations are also discussed as future directions such as immune-specific targeting and implementation of artificial intelligence algorithms.

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18F-FCho PET and MRI for the prediction of response in glioblastoma patients according to the RANO criteria

Cited by 22 publications

References 34 publications

Practical Needs in Assessing Response to Therapy in Operated Brain High Grade Glioma According to Response Assessment in Neuro-Oncology Criteria

Practical Needs in Assessing Response to Therapy in Operated Brain High Grade Glioma According to Response Assessment in Neuro-Oncology Criteria

A perspective on the radiopharmaceutical requirements for imaging and therapy of glioblastoma

Imaging-guided precision medicine in glioblastoma patients treated with immune checkpoint modulators: research trend and future directions in the field of imaging biomarkers and artificial intelligence

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