O-(2-[18F]fluoroethyl)-L-tyrosine PET for monitoring the effects of convection-enhanced delivery of paclitaxel in patients with recurrent glioblastoma
O-(2-[18F]fluoroethyl)-L-tyrosine PET for monitoring the effects of convection-enhanced delivery of paclitaxel in patients with recurrent glioblastoma
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DOI：
10.1007/s00259-005-1819-7
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发表时间：
2005-09-01
影响因子：
9.1
通讯作者：
Tatsch, K
中科院分区：
文献类型：
--
作者：
Pöpperl, G;Goldbrunner, R;Tatsch, K
目的：紫杉醇对流增强给药(CED)是治疗复发性胶质母细胞瘤的一种新的局部治疗方法。本研究的目的是评价O-(2-[F-18]氟乙基)-L酪氨酸正电子发射断层扫描在监测这种直接给药方式中的作用。方法：8例复发的胶质母细胞瘤患者接受了紫杉醇的CED治疗，紫杉醇通过立体定向的导管注入肿瘤内。治疗前和治疗后4周分别进行FET、PET和MRI检查，每隔3个月进行一次随访。对于定量评估，计算SUVmax(肿瘤)/SUVean(背景)比率。结果：基线时所有肿瘤均显示Gd强化和高FET摄取(SUVmax/BG 3.2+/-0.8)。CED后4周，FET摄取显著减少(SUVmax/BG-17%；p<；0.01)。随访期间，CED范围内未见复发。在8名肿瘤扩大的患者中，有2人在治疗4个月和5个月后死亡，最有可能是死于局部并发症。8名患者中有6名患者病情暂时稳定，FET摄取稳定；在CED后3-13个月，5名患者病情恶化，远离CED区域的FET摄取率增加(+46%)。1例患者在CED后10个月仍有稳定的FET摄取。MRI显示不变/增加的对比度增强和水肿，不能可靠地评估疾病的进展。结论：FET-PET是监测紫杉醇CED疗效的有价值的工具。在长期的随访中，稳定或减少的FET摄取，即使在对比剂增强的病变中，也提示反应性变化，而比率的增加似乎总是预示复发。因此，在区分稳定期疾病和肿瘤复发方面，FET PET比MRI更可靠。
Purpose: Convection-enhanced delivery (CED) of paclitaxel is a new locoregional approach for patients with recurrent glioblastoma. The aim of this study was to evaluate O-(2-[F-18]fluoroethyl)-L-tyrosine (FET) positron emission tomography (PET) in monitoring the effects of this type of direct drug delivery. Methods: Eight patients with recurrent glioblastoma underwent CED of paclitaxel, which was infused over stereotactically placed catheters into the tumour. FET PET and MRI were performed before and 4 weeks after therapy and then at 3-month intervals to document follow-up. For quantitative evaluation, SUVmax(tumour)/SUVmean(background) ratios were calculated. Results: At baseline all tumours showed gadolinium enhancement and high FET uptake (SUVmax/BG 3.2 +/- 0.8). Four weeks after CED, a statistically significant decrease in FET uptake was seen (SUVmax/BG -17%; p < 0.01). During follow-up, no recurrence was observed within the CED area. Two out of eight patients with extended tumours died 4 and 5 months after treatment, most probably from local complications. Temporarily stable disease with stable FET uptake was observed in six of eight patients; this was followed by progression and increasing FET uptake ratios (+46%) distant from the CED area in five of the six patients 3-13 months after CED. One patient still presents stable FET uptake 10 months after CED. MRI showed unchanged/increasing contrast enhancement and oedema without ability to reliably assess disease progression. Conclusion: FET PET is a valuable tool in monitoring the effects of CED of paclitaxel. In long-term follow-up, stable or decreasing FET uptake, even in contrast-enhancing lesions, is suggestive of reactive changes, whereas increasing ratios appear always to be indicative of recurrence. Therefore, FET PET is more reliable than MRI in differentiating stable disease from tumour regrowth.