Dietmar Waitz

O-(2-18F-fluoroethyl)-L-tyrosine PET predicts failure of antiangiogenic treatment in patients with recurrent high-grade glioma.

The objective of this study was to compare MRI response assessment with metabolic O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) PET response evaluation during antiangiogenic treatment in patients with recurrent high-grade glioma (rHGG). Methods: Eleven patients with rHGG were treated biweekly with bevacizumab–irinotecan. MR images and 18F-FET PET scans were obtained at baseline and at follow-up 8–12 wk after treatment onset. MRI treatment response was evaluated by T1/T2 volumetry according to response assessment in neurooncology (RANO) criteria. For 18F-FET PET evaluation, an uptake reduction of more than 45% calculated with a standardized uptake value of more than 1.6 was defined as a metabolic response (receiver-operating-characteristic curve analysis). MRI and 18F-FET PET volumetry results and response assessment were compared with each other and in relation to progression-free survival (PFS) and overall survival (OS). Results: At follow-up, MR images showed partial response in 7 of 11 patients (64%), stable disease in 2 of 11 patients (18%), and tumor progression in 2 of 11 patients (18%). In contrast, 18F-FET PET revealed 5 of 11 metabolic responders (46%) and 6 of 11 nonresponders (54%). MRI and 18F-FET PET showed that responders survived significantly longer than did nonresponders (10.24 vs. 4.1 mo, P = 0.025, and 7.9 vs. 2.3 mo, P = 0.015, respectively). In 4 patients (36.4%), diagnosis according to RANO criteria and 18F-FET PET was discordant. In these cases, PET was able to detect tumor progression earlier than was MRI. Conclusion: In rHGG patients undergoing antiangiogenic treatment, 18F-FET PET seems to be predictive for treatment failure in that it contributes important information to response assessment based solely on MRI and RANO criteria.

Functional imaging in phaeochromocytoma and neuroblastoma with 68Ga-DOTA-Tyr3-octreotide positron emission tomography and 123I-metaiodobenzylguanidine: a clarification

Purpose 68Ga-DOTA-Tyr3-octreotide positron emission tomography (68Ga-DOTA-TOC PET) has proven to be superior to 111In-DTPA-D-Phe1-octreotide (111In-octreotide) planar scintigraphy and SPECT imaging in neuroendocrine tumours (NETs). Because of these promising results, we compared the accuracy of 123I-metaiodobenzylguanidine (123I-MIBG) imaging with PET in the diagnosis and staging of metastatic phaeochromocytoma and neuroblastoma, referring to radiological imaging as reference standard.

Treatment of high-grade glioma with radiolabeled peptides.

The management of high-grade glioma (HGG) patients in clinical routine represents a challenging task. HGG has a poor prognosis because of early recurrence or therapy-refractory disease following first-line standard therapy, which includes a multidisciplinary approach involving radical surgical resection followed by external beam radiation therapy in combination with chemotherapy. Glioma cells are known to express specific receptors or glycoproteins on their surface which can be used as biological targets for treatment. The application of radiopharmaceuticals consisting of a targeting and an effector domain has led to the introduction of new treatment approaches, aiming at a tumor-specific treatment sparing normal brain tissue. One of these new modalities is the peptide receptor radionuclide therapy (PRRT). Peptides labeled with radioactive nuclides can bind directly to the tumor cells and deliver high doses of radioactivity directly to the tumor tissue. This article reviews the literature for PRRT in HGG.

Effects of Music on the Psyche of Neuroendocrine Tumour Patients Undergoing Peptide Receptor Radionuclide Therapy

Radionuclide peptide receptor-based therapy (PRRT) is an established therapeutic option in inoperable metastatic neuroendocrine tumours (NETs), who show somatostatin receptor (SSTR) expression in SSTR scintigraphy. According to the Innsbruck protocol for performing PRRT our department for PRRT only few side effects are observed. PRRT is generally very well tolerated, and the results favour the combined use of radiolabeled SST analogues providing a customised therapy strategy for tumour control in advanced stages. Overall response rates (minor response, partial remission, stable disease) to PRRT are more than 75 %, and even in patients with progressive disease palliation of tumour-related symptoms may be observed. In patients with advanced disease stages, older age, poor Karnovsky performance index and diminished organ function due to pre-treatment with chemotherapy, radioactivity doses should be adapted to the individual situation. An improvement of quality of life parameters is documented in many of the NET patients reported by the EORTC questionnaire which covers the global well-being of the patient. PRRT is well established in the treatment of NET patients suffering progressive, metastatic disease. These patients are often confronted with the diagnosis of a growing tumor and only few well established treatment options. However, the treatment with high dose radioactivity is not commonly known and may cause a certain anxiety level. A correlation between music and human biology has been described and “music therapy” has been applied in different medical treatments. In a randomised controlled study, we examined the influence of systematic application of music via MP3 players on the psyche of NET patients undergoing PRRT. In both groups of patients receiving music or not, a statistically significant difference could be measured for the global severity index (i.e. a measure for the self-reported clinically relevant psychological symptoms) between the day of admittance and the day of remission from our therapy unit, but the effect was more pronounced in the music group. Furthermore, during application of PRRT a significant reduction of the acute anxiety level was observed in both groups, and this effect was more pronounced in the patient group receiving music, and was statistically significant after application of radioactivity between the music group and the control group. We conclude that selected music positively influences patient care by reducing the acute anxiety level during application of PRRT as well as by reducing clinically relevant psychological symptoms.