18F-Fluciclovine PET to distinguish treatment-related effects from disease progression in recurrent glioblastoma: PET fusion with MRI guides neurosurgical sampling

Fraser Henderson Jr, Steven Brem, Donald M O'Rourke, MacLean Nasrallah, Vivek P Buch, Anthony J Young, Robert K Doot, Austin Pantel, Arati Desai, Stephen J Bagley, S Ali Nabavizadeh, Fraser Henderson Jr, Steven Brem, Donald M O'Rourke, MacLean Nasrallah, Vivek P Buch, Anthony J Young, Robert K Doot, Austin Pantel, Arati Desai, Stephen J Bagley, S Ali Nabavizadeh

Abstract

Differentiation of true tumor progression from treatment-related effects remains a major unmet need in caring for patients with glioblastoma. Here, we report how the intraoperative combination of MRI with18F-fluciclovine PET guided surgical sampling in 2 patients with recurrent glioblastoma.18F-Fluciclovine PET is FDA approved for use in prostate cancer and carries an orphan drug designation in glioma. To investigate its utility in recurrent glioblastoma, we fused PET and MRI images using 2 different surgical navigation systems and performed targeted stereotactic biopsies from the areas of high ("hot") and low ("cold") radiotracer uptake. Concordant histopathologic and imaging findings suggest that a combined18F-fluciclovine PET-MRI-guided approach can guide neurosurgical resection of viable recurrent glioblastoma in the background of treatment-related effects, which can otherwise look similar on MRI.

Keywords: 18F-fluciclovine; glioblastoma; positron emission tomography (PET); pseudoprogression.

© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology.

Figures

Fig. 1
Fig. 1
Case A. At 16 months after initial resection, A, T1 postcontrast MRI shows gradual progression of nodular enhancement around the surgical cavity with a satellite nodule anteriorly, and surrounding hyperintensity on B, fluid-attenuated inversion recovery. C, Source perfusion images demonstrate marked susceptibility artifact due to blood products at the resection site, making the D relative cerebral blood volume perfusion map nondiagnostic. E and F, Two 18F-fluciclovine PET–avid sites (biopsy 1 and biopsy 2) and G, 1 non–PET-avid site (biopsy 3), were sampled (white arrows). Intraoperative navigation was used to stereotactically identify the sites after registration of the images to the navigation software. E, F, and G, Orange navigation cross-hairs are faintly visible.
Fig. 2
Fig. 2
Case A. Images stained with hematoxylin and eosin compare A, biopsy 2, a “hot” PET-avid site, vs B, biopsy 3, a “cold” site, contrasting predominant findings of A, tumor recurrence vs B, treatment effect. Malignant cells with hyperchromatic chromatin and abundant mitotic activity are noted in A, whereas a high macrophage population is seen in B. Images taken at 20× objective (with a 10× eye piece, total magnification 200×). The scale bar in Figure 2A is 100 μm.
Fig. 3
Fig. 3
Case B. Nodular enhancement posterior to the resection cavity in left parietal lobe on A, T1 postcontrast, and with adjacent hyperintensity on B, fluid-attenuated inversion recovery images. C, Source perfusion image and relative cerebral blood volume (rCBV) map demonstrate D, elevated rCBV corresponding to the nodular and rim enhancement at A, left parietal surgical cavity. E and F, Three 18F-fluciclovine PET-avid biopsy sites are shown (E, small arrow, biopsy 1; larger arrow, biopsy 2; F, arrow, biopsy 3).

References

    1. Fink J, Born D, Chamberlain MC. Pseudoprogression: relevance with respect to treatment of high-grade gliomas. Curr Treat Options Oncol. 2011;12(3):240–252.
    1. Rowe LS, Butman JA, Mackey M, et al. . Differentiating pseudoprogression from true progression: analysis of radiographic, biologic, and clinical clues in GBM. J Neurooncol. 2018;139(1):145–152.
    1. Jang BS, Jeon SH, Kim IH, Kim IA.. Prediction of pseudoprogression versus progression using machine learning algorithm in glioblastoma. Sci Rep. 2018;8(1):12516.
    1. Patel P, Baradaran H, Delgado D, et al. . MR perfusion-weighted imaging in the evaluation of high-grade gliomas after treatment: a systematic review and meta-analysis. Neuro Oncol. 2017;19(1):118–127.
    1. Okada H, Weller M, Huang R, et al. . Immunotherapy response assessment in neuro-oncology: a report of the RANO Working Group. Lancet Oncol. 2015;16(15):e534–e542.
    1. Bach-Gansmo T, Nanni C, Nieh PT, et al. . Multisite experience of the safety, detection rate and diagnostic performance of fluciclovine (18F) positron emission tomography/computerized tomography imaging in the staging of biochemically recurrent prostate cancer. J Urol. 2017;197(3 pt 1):676–683.
    1. Ulaner GA, Goldman DA, Gönen M, et al. . Initial results of a prospective clinical trial of 18F-fluciclovine PET/CT in newly diagnosed invasive ductal and invasive lobular breast cancers. J Nucl Med. 2016;57(9):1350–1356.
    1. Bogsrud TV, Londalen A, Brandal P, et al. . 18F-fluciclovine PET/CT in suspected residual or recurrent high-grade glioma. Clin Nucl Med. 2019;44(8):605–611.
    1. Michaud L, Beattie BJ, Akhurst T, et al. . 18F-Fluciclovine (18F-FACBC) PET imaging of recurrent brain tumors [published online ahead of print August 15, 2019]. Eur J Nucl Med Mol Imaging. doi:10.1007/s00259-019-04433-1.
    1. Bagley SJ, Schwab RD, Nelson E, et al. . Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma. J Neurooncol. 2019;141(2):421–429.
    1. Osuka S, Van Meir EG. Overcoming therapeutic resistance in glioblastoma: the way forward. J Clin Invest. 2017;127(2):415–426.
    1. Karlberg A, Berntsen EM, Johansen H, et al. . Multimodal 18F-fluciclovine PET/MRI and ultrasound-guided neurosurgery of an anaplastic oligodendroglioma. World Neurosurg. 2017; 108:989.e1–989.e8.
    1. Galldiks N, Dunkl V, Stoffels G, et al. . Diagnosis of pseudoprogression in patients with glioblastoma using O-(2-[18F]fluoroethyl)-L-tyrosine PET. Eur J Nucl Med Mol Imaging. 2015;42(5):685–695.
    1. Suchorska B, Jansen NL, Linn J, et al. ; German Glioma Network Biological tumor volume in 18FET-PET before radiochemotherapy correlates with survival in GBM. Neurology. 2015;84(7):710–719.
    1. Shoup TM, Olson J, Hoffman JM, et al. . Synthesis and evaluation of [18F]1-amino-3-fluorocyclobutane-1-carboxylic acid to image brain tumors. J Nucl Med. 1999;40(2):331–338.
    1. Savir-Baruch B, Zanoni L, Schuster DM. Imaging of prostate cancer using Fluciclovine. Urol Clin North Am. 2018;45(3):489–502.
    1. US Department of Health and Human Services. US Food and Drug Administration. Search Orphan Drug Designations and Approvals . 2015. Accessed September 9, 2019.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit