Preoperative [11C]methionine PET to personalize treatment decisions in patients with lower-grade gliomas. Issue 9 (16th February 2022)

• Record Type: Journal Article
• Authors: Ninatti, Gaia; Sollini, Martina; Bono, Beatrice; Gozzi, Noemi; Fedorov, Daniil; Antunovic, Lidija; Gelardi, Fabrizia; Navarria, Pierina; Politi, Letterio S; Pessina, Federico; Chiti, Arturo
• Is Part Of: Neuro-oncology. Volume 24:Issue 9(2022)
• Page Start: 1546
• Page End: 1556
• Publication Date: 2022-02-16
• Subjects: brain tumors -- lower-grade gliomas -- [11C]methionine PET -- prognosis -- surgery; Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noac040
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: Background: PET with radiolabeled amino acids is used in the preoperative evaluation of patients with glial neoplasms. This study aimed to assess the role of [ 11 C]methionine (MET) PET in assessing molecular features, tumor extent, and prognosis in newly diagnosed lower-grade gliomas (LGGs) surgically treated. Methods: One hundred and fifty-three patients with a new diagnosis of grade 2/3 glioma who underwent surgery at our Institution and were imaged preoperatively using [ 11 C]MET PET/CT were retrospectively included. [ 11 C]MET PET images were qualitatively and semi-quantitatively analyzed using tumor-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 [ 11 C]MET PET, respectively. [ 11 C]MET uptake was more common in oligodendrogliomas than IDH -mutant astrocytomas (87% vs 50% of cases, respectively). Among [ 11 C]MET-positive gliomas, grade 3 oligodendrogliomas had the highest median TBRmax (3.22). In 25% of patients, PET helped to better delineate tumor margins compared to MRI only. In IDH -mutant astrocytomas, higher TBRmax values at [ 11 C]MET PET were independent predictors of shorter PFS. Conclusions: This work highlights the role of preoperative [ 11 C]MET PET in estimating the type of suspected LGGs, assessing tumor extent, and predicting biological behavior and prognosis of histologically confirmed LGGs. Our findings support the implementation of [ 11 C]MET PET in routine clinical practice to better manage these neoplasms.