Publications by authors named "Galldiks N"
One of the most common clinical indications for amino acid PET using the tracer -(2-[F]-fluoroethyl)-l-tyrosine (F-FET) is the differentiation of tumor relapse from treatment-related changes in patients with gliomas. A subset of patients may present with an uptake of F-FET close to recommended threshold values. The goal of this study was to investigate the frequency of borderline cases and the role of quantitative F-FET PET parameters in this situation.
View Article and Find Full Text PDFBackground: Despite advances in our understanding of the molecular underpinnings of meningioma progression and innovations in systemic and local treatments, recurrent meningiomas remain a substantial therapeutic challenge. The objective of this systematic review and meta-analysis is to provide a historical baseline, contemporary analysis, and propose a "rate of probable interest" to inform future clinical trial design and development on behalf of the RANO meningioma group.
Methods: PubMed, ClinicalTrials.
Purpose: Especially in Europe, amino acid PET is increasingly integrated into multidisciplinary neuro-oncological tumor boards (MNTBs) to overcome diagnostic uncertainties such as treatment-related changes. We evaluated the accuracy of MNTB decisions that included the O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) PET information compared with FET PET results alone to differentiate tumor relapse from treatment-related changes.
Patients And Methods: In a single academic center, we retrospectively evaluated 180 MNTB decisions of 151 patients with CNS WHO grade 3 or 4 gliomas (n = 122) or brain metastases (n = 29) presenting equivocal MRI findings following anticancer treatment.
This joint practice guideline/procedure standard was collaboratively developed by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neuro-Oncology (EANO), and the PET task force of the Response Assessment in Neurooncology Working Group (PET/RANO). Brain metastases are the most common malignant central nervous system (CNS) tumors. PET imaging with radiolabeled amino acids and to lesser extent [F]FDG has gained considerable importance in the assessment of brain metastases, especially for the differential diagnosis between recurrent metastases and treatment-related changes which remains a limitation using conventional MRI.
View Article and Find Full Text PDFThe phase-3 INDIGO trial demonstrated that the isocitrate dehydrogenase () inhibitor vorasidenib significantly prolonged progression-free survival and delayed intervention in patients with CNS WHO grade 2 gliomas. However, conventional MRI showed limited response, with only 11% of patients having objective responses. Studies suggest that serial PET imaging with radiolabeled amino acids, such as -(2-[ F]-fluoroethyl)-L-tyrosine (FET) PET, may provide earlier and more informative assessments of treatment response than MRI.
View Article and Find Full Text PDFArticle Synopsis
- Technological advancements are enhancing the use of computational methods in fields like health care, particularly in neuro-oncology, to improve clinical decision-making through various biomarkers.
- Artificial intelligence (AI) algorithms, including radiomics, are being increasingly integrated, but challenges like generalizability and validation hinder their widespread application.
- This Policy Review aims to provide recommendations for standardizing AI practices in health care, focusing on neuro-oncology, while discussing the importance of reliable AI for future clinical trials.
The development, application, and benchmarking of artificial intelligence (AI) tools to improve diagnosis, prognostication, and therapy in neuro-oncology are increasing at a rapid pace. This Policy Review provides an overview and critical assessment of the work to date in this field, focusing on diagnostic AI models of key genomic markers, predictive AI models of response before and after therapy, and differentiation of true disease progression from treatment-related changes, which is a considerable challenge based on current clinical care in neuro-oncology. Furthermore, promising future directions, including the use of AI for automated response assessment in neuro-oncology, are discussed.
View Article and Find Full Text PDFPurpose: This guideline will discuss radiotherapeutic management of IDH-mutant grade 2 and grade 3 diffuse glioma, using the latest 2021 WHO (5th) classification of brain tumours focusing on: imaging modalities, tumour volume delineation, irradiation dose and fractionation.
Methods: The ESTRO Guidelines Committee, CNS subgroup, nominated 15 European experts who identified questions for this guideline. Four working groups were established addressing specific questions concerning imaging, target volume delineation, radiation techniques and fractionation.
Background: Maximum tumor resection improves overall survival (OS) in patients with glioblastoma. The extent of resection (EOR) is historically dichotomized. The RANO resect group recently proposed criteria for volumetry-based EOR assessment in patients that were treated according to Stupp´s protocol.
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- Targeted radionuclide therapy is a new treatment option for metastatic cancer that uses nuclear medicine to identify and target tumors based on specific markers.
- This therapy can complement traditional radiotherapy, especially when imaging techniques like MRI miss microscopic metastases.
- Current approved uses include treating certain thyroid and prostate cancers, while ongoing research is exploring additional targets, with potential effectiveness against brain metastases if the necessary targets are present.
Theranostics integrate molecular imaging and targeted radionuclide therapy for personalised cancer therapy. Theranostic treatments have shown meaningful efficacy in randomised clinical trials and are approved for clinical use in prostate cancer and neuroendocrine tumours. Brain tumours represent an unmet clinical need and theranostics might offer effective treatment options, although specific issues need to be considered for clinical development.
View Article and Find Full Text PDFAccording to the new WHO classification of 2021, gliomas are a heterogeneous group of tumors with very different histology, molecular genetics, and prognoses. In addition to glioblastomas, the most common gliomas, there are also numerous less common gliomas, some of which have a very favorable prognosis. Targeted radionuclide therapy is a therapeutic option that can be attractive if a tumor can be targeted based on its molecular characteristics.
View Article and Find Full Text PDFBackground: Neuro-oncology patients and caregivers should have equitable access to rehabilitation, supportive-, and palliative care. To investigate existing issues and potential solutions, we surveyed neuro-oncology professionals to explore current barriers and facilitators to screening patients' needs and referral to services.
Methods: Members of the European Association of Neuro-Oncology and the European Organisation for Research and Treatment of Cancer Brain Tumor Group (EORTC-BTG) were invited to complete a 39-item online questionnaire covering the availability of services, screening, and referral practice.
Article Synopsis
- PET imaging using amino acid tracers is increasingly utilized alongside MRI in managing glioma patients, with international guidelines being developed to standardize its use.
- Health insurance agencies in Europe are starting to reimburse amino acid PET, indicating its growing relevance in clinical settings, while advancements in AI and radiomics may enhance tumor detection and treatment evaluation.
- New technologies, including next-generation PET scanners and innovative PET tracers for targeted therapies, are expanding the applications of PET imaging in Neuro-Oncology, although further validation of these innovations is needed.
Purpose: To provide practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor (SSTR) ligands.
Methods: This joint practice guideline/procedure standard was collaboratively developed by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the European Association of Neurooncology (EANO), and the PET task force of the Response Assessment in Neurooncology Working Group (PET/RANO).
Results: Positron emission tomography (PET) using somatostatin receptor (SSTR) ligands can detect meningioma tissue with high sensitivity and specificity and may provide clinically relevant information beyond that obtained from structural magnetic resonance imaging (MRI) or computed tomography (CT) imaging alone.
Objectives: Achieving a consensus on a definition for different aspects of radiomics workflows to support their translation into clinical usage. Furthermore, to assess the perspective of experts on important challenges for a successful clinical workflow implementation.
Materials And Methods: The consensus was achieved by a multi-stage process.
Article Synopsis
- - Meningiomas are the most common primary brain tumors in adults, with an increasing incidence linked to aging and better neuroimaging, and while many are benign, some are aggressive and treatment-resistant, leading to serious health impacts.
- - Recent advancements in understanding meningioma biology have introduced molecular biomarkers for diagnosis and prognosis, but a standardized molecular classification for these tumors is still lacking.
- - A comprehensive consensus review by the International Consortium on Meningiomas aims to guide clinicians and researchers by covering proposed classifications, novel treatment strategies, ongoing studies, and unique management approaches for different patient populations.
PET using the radiolabeled amino acid -(2-[F]fluoroethyl)-l-tyrosine (F-FET) has been shown to be of value for treatment monitoring in patients with brain metastases after multimodal therapy, especially in clinical situations with equivocal MRI findings. As medical procedures must be justified socioeconomically, we determined the effectiveness and cost-effectiveness of F-FET PET for treatment monitoring of multimodal therapy, including checkpoint inhibitors, targeted therapies, radiotherapy, and combinations thereof in patients with brain metastases secondary to melanoma or non-small cell lung cancer. We analyzed already-published clinical data and calculated the associated costs from the German statutory health insurance system perspective.
View Article and Find Full Text PDFBackground: The utility of liquid biopsies is well documented in several extracranial and intracranial (brain/leptomeningeal metastases, gliomas) tumors.
Methods: The RANO (Response Assessment in Neuro-Oncology) group has set up a multidisciplinary Task Force to critically review the role of blood and cerebrospinal fluid (CSF)-liquid biopsy in CNS lymphomas, with a main focus on primary central nervous system lymphomas (PCNSL).
Results: Several clinical applications are suggested: diagnosis of PCNSL in critical settings (elderly or frail patients, deep locations, and steroid responsiveness), definition of minimal residual disease, early indication of tumor response or relapse following treatments, and prediction of outcome.
This Expert Panel Narrative Review explores the current status of advanced MRI and PET techniques for the posttherapeutic response assessment of high-grade adult-type gliomas, focusing on ongoing clinical controversies in current practice. Discussed techniques that complement conventional MRI and aid the differentiation of recurrent tumor from posttreatment effects include DWI and diffusion-tensor imaging; perfusion MRI techniques including dynamic susceptibility contrast (DSC), dynamic contrast-enhanced, and arterial spin labeling MRI; MR spectroscopy (MRS) including assessment of 2-hydroxyglutarate (2HG) concentration; glucose- and amino acid (AA)-based PET; and amide proton transfer imaging. Updated criteria for the Response Assessment in Neuro-Oncology are presented.
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- Brain tumor diagnostics have progressed with techniques like PET and advanced MRI, aiding in tumor differentiation, extent evaluation, and treatment response assessment.
- Joint recommendations from major medical groups emphasize the significant value of using radiolabeled amino acids alongside standard MRI for better clinical outcomes.
- Despite their importance, these imaging methods face challenges that need to be addressed through standardized protocols and interdisciplinary collaboration to enhance patient care in brain tumor management.