C-11-Methionine Positron Emission Tomographic Imaging of Biologic Activity of a Recurrent Glioblastoma Treated with Stereotaxy-Guided Laser-Induced Interstitial Thermotherapy

University of Cologne, Köln, North Rhine-Westphalia, Germany
Molecular Imaging (Impact Factor: 1.96). 09/2012; 11(4):1-7. DOI: 10.2310/7290.2011.00046
Source: PubMed


In patients with recurrent glioblastoma multiforme (GBM), local minimally invasive treatment modalities have gained increasing interest recently because they are associated with fewer side effects than open surgery. For example, local tumor coagulation by laser-induced interstitial thermotherapy (LITT) is such a minimally invasive technique. We monitored the metabolic effects of stereotaxy-guided LITT in a patient with a recurrent GBM using amino acid positron emission tomography (PET). Serial 11C-methyl-l-methionine positron emission tomography (MET-PET) and contrast-enhanced computed tomography (CT) were performed using a hybrid PET/CT system in a patient with recurrent GBM before and after LITT. To monitor the biologic activity of the effects of stereotaxy-guided LITT, a threshold-based volume of interest analysis of the metabolically active tumor volume (MET uptake index of ≥ 1.3) was performed. A continuous decline in metabolically active tumor volume after LITT could be observed. MET-PET seems to be useful for monitoring the short-term therapeutic effects of LITT, especially when patients have been pretreated with a multistep therapeutic regimen. MET-PET seems to be an appropriate tool to monitor and guide experimental LITT regimens and should be studied in a larger patient group to confirm its clinical value.

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    • "The ablative heat generated causes necrosis in the tumor. This procedure has been used clinically in many tissues, including the brain [3] [4] [5] [6] [7] [8] [9] [10] [11], liver [12], lung [13], bone [14], and prostate [15]. "
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    ABSTRACT: Magnetic resonance-guided laser induced thermotherapy (MRgLITT) has become an increasingly relevant therapy for tumor ablation due to its minimally invasive approach and broad applicability across many tissue types. The current state of the art applies laser irradiation via cooled optical fiber applicators in order to generate ablative heat and necrosis in tumor tissue. Magnetic resonance temperature imaging (MRTI) is used concurrently with this therapy to plan treatments and visualize tumor necrosis. Though application in neurosurgery remains in its infancy, MRgLITT has been found to be a promising therapy for many types of brain tumors. This review examines the current use of MRgLITT with regard to the special clinical challenge of glioblastoma multiforme and examines the potential applications of next-generation nanotherapy specific to the treatment of glioblastoma.
    Full-text · Article · Jan 2014
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    ABSTRACT: Routine diagnostics and treatment monitoring of brain tumors is usually based on magnetic resonance imaging (MRI), but the capacity of conventional MRI to differentiate tumor tissue from nonspecific tissue changes may be limited especially after therapeutic interventions such as neurosurgical resection, radiotherapy, and chemotherapy. Molecular imaging using positron-emission tomography (PET) may provide relevant additional information on tumor metabolism, which allows for more accurate diagnostics especially in clinically equivocal situations. In the last decades, a variety of molecular targets have been addressed by specific PET tracers, but only a few have achieved relevance in routine clinical practice. This book chapter is focussed on PET tracers that appear to be especially helpful in clinical decision-making with regard to a better delineation of brain tumors, prognosis, and grading, improved differentiation of tumor recurrence from nonspecific posttherapeutic changes, and treatment monitoring.
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    ABSTRACT: In 1891, an orthopedic surgeon in New York noted the disappearance of an inoperable sarcoma in a patient after a febrile illness. This observation resulted in experiments assessing the utility of heat therapy or thermotherapy for the treatment of cancer. While it initially fell from favor, thermotherapy has recently made a resurgence, sparking investigations into its anticancer properties. This therapy is especially attractive for glioblastoma multiforme (GBM) which is difficult to target due to the blood-brain barrier and recalcitrant to treatment. Here we briefly review the history of thermotherapy and then more methodically present the current literature as it relates to central nervous system malignancies. Recent developments show that heat is preferentially cytotoxic to tumor cells and induces cellular pathways which result in apoptotic and non-apoptotic death. Techniques to induce hyperthermia include regional hyperthermia by water bath, focused ultrasound, radiofrequency microwaves, laser-induced interstitial thermotherapy, and magnetic energy. The recent revival of these therapeutic approaches and their preliminary outcomes in the treatment of GBM is reviewed. From bacterial toxins to infusion of magnetic nanoparticles, hyperthermia has the potential to be an effective and easy-to-execute adjuvant therapy for GBM. Hyperthermia for GBM is a promising therapy as part of a growing armamentarium for malignant glioma treatment.
    Full-text · Article · Feb 2014 · Anticancer research
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