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Eur J Nucl Med Mol Imaging. 2019 Mar;46(3):558-568. doi: 10.1007/s00259-018-4240-8. Epub 2019 Jan 5.

18F-DOPA PET/CT in brain tumors: impact on multidisciplinary brain tumor board decisions.

Author information

1
Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06100, Nice, France. ohumbert@unice.fr.
2
TIRO-UMR E 4320, UCA/CEA, Nice, France. ohumbert@unice.fr.
3
Clinical Research and Innovation Office, UCA, Nice, France. ohumbert@unice.fr.
4
Department of Neurology, Pasteur 2 University Hospital, UCA, Nice, France.
5
Department of Neuroradiology, Pasteur 2 University Hospital, UCA, Nice, France.
6
Department of Biostatistics, Centre Antoine-Lacassagne, UCA, Nice, France.
7
Department of Radiotherapy, Centre Antoine-Lacassagne, UCA, Nice, France.
8
Department of Neurosurgery, Pasteur 2 University Hospital, UCA, Nice, France.
9
Department of Medical Oncology, Centre Antoine-Lacassagne, UCA, Nice, France.
10
Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06100, Nice, France.
11
TIRO-UMR E 4320, UCA/CEA, Nice, France.
12
Central Laboratory of Pathology, Pasteur I University Hospital, UCA, Nice, France.

Abstract

PURPOSE:

This study aimed to assess the therapeutic impact and diagnostic accuracy of 18F-DOPA PET/CT in patients with glioblastoma or brain metastases.

METHODS:

Patients with histologically proven glioblastoma or brain metastases were prospectively included in this monocentric clinical trial (IMOTEP). Patients were included either due to a clinical suspicion of relapse or to assess residual tumor infiltration after treatment. Multimodality brain MRI and 18F-DOPA PET were performed. Patients' data were discussed during a Multidisciplinary Neuro-oncology Tumor Board (MNTB) meeting. The discussion was first based on clinical and MRI data, and an initial diagnosis and treatment plan were proposed. Secondly, a new discussion was conducted based on the overall imaging results, including 18F-DOPA PET. A second diagnosis and therapeutic plan were proposed. A retrospective and definitive diagnosis was obtained after a 3-month follow-up and considered as the reference standard.

RESULTS:

One hundred six cases were prospectively investigated by the MNTB. All patients with brain metastases (N = 41) had a clinical suspicion of recurrence. The addition of 18F-DOPA PET data changed the diagnosis and treatment plan in 39.0% and 17.1% of patients' cases, respectively. Concerning patients with a suspicion of recurrent glioblastoma (N = 12), the implementation of 18F-DOPA PET changed the diagnosis and treatment plan in 33.3% of cases. In patients evaluated to assess residual glioblastoma infiltration after treatment (N = 53), 18F-DOPA PET data had a lower impact with only 5.7% (3/53) of diagnostic changes and 3.8% (2/53) of therapeutic plan changes. The definitive reference diagnosis was available in 98/106 patients. For patients with tumor recurrence suspicion, the adjunction of 18F-DOPA PET increased the Younden's index from 0.44 to 0.53 in brain metastases and from 0.2 to 1.0 in glioblastoma, reflecting an increase in diagnostic accuracy.

CONCLUSION:

18F-DOPA PET has a significant impact on the management of patients with a suspicion of brain tumor recurrence, either glioblastoma or brain metastases, but a low impact when used to evaluate the residual glioblastoma infiltration after a first-line radio-chemotherapy or second-line bevacizumab.

KEYWORDS:

18F-DOPA; Amino acid; Brain tumours; PET; Therapeutic impact

PMID:
30612162
DOI:
10.1007/s00259-018-4240-8

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