MRI and F-FET PET for Multimodal Treatment Monitoring in Patients with Brain Metastases: A Cost-Effectiveness Analysis.

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.

Advances in PET imaging for meningioma patients.

In patients with meningioma, diagnosis and treatment planning are predominantly based on anatomical imaging using MRI or CT. Constraints of these imaging modalities include precise meningioma delineation-especially at the skull base, in the case of -osseus growth, and in tumors with complex geometry-and the differentiation of post-therapeutic reactive changes from meningioma relapse. Advanced metabolic imaging using PET may help to characterize specific metabolic and cellular features providing additional information beyond the information derived from anatomical imaging alone.

Clinical applications and prospects of PET imaging in patients with IDH-mutant gliomas.

PET imaging using radiolabeled amino acids in addition to MRI has become a valuable diagnostic tool in the clinical management of patients with brain tumors. This review provides a comprehensive overview of PET studies in glioma patients with a mutation in the isocitrate dehydrogenase gene (IDH). A considerable fraction of these tumors typically show no contrast enhancement on MRI, especially when classified as grade 2 according to the World Health Organization classification of Central Nervous System tumors.

An updated review on the diagnosis and assessment of post-treatment relapse in brain metastases using PET.

Introduction: Brain metastases in patients with extracranial cancer are typically associated with increased morbidity and mortality. Stereotactic radiotherapy and immunotherapy using checkpoint inhibitors currently are essential in brain metastases treatment. Since conventional contrast-enhanced MRI alone cannot reliably differentiate between treatment-induced changes and brain metastasis relapse, several studies investigated the role of PET imaging and, more recently, radiomics, based on routinely acquired PET images, to overcome this clinically relevant challenge.

Prediction of response to lomustine-based chemotherapy in glioma patients at recurrence using MRI and FET PET.

Background: We evaluated O-(2-[18F]fluoroethyl)-l-tyrosine (FET) PET and MRI for early response assessment in recurrent glioma patients treated with lomustine-based chemotherapy.

Methods: Thirty-six adult patients with WHO CNS grade 3 or 4 gliomas (glioblastoma, 69%) at recurrence (median number of recurrences, 1; range, 1-3) were retrospectively identified. Besides MRI, serial FET PET scans were performed at baseline and early after chemotherapy initiation (not later than two cycles).

Efficacy and tolerability of regorafenib in pretreated patients with progressive CNS grade 3 or 4 gliomas.

Background: The phase 2 REGOMA trial suggested an encouraging overall survival benefit in glioblastoma patients at first relapse treated with the multikinase inhibitor regorafenib. Here, we evaluated the efficacy and side effects of regorafenib in a real-life setting.

Methods: From 2018 to 2021, 30 patients with progressive WHO CNS grade 3 or 4 gliomas treated with regorafenib (160 mg/day; first 3 weeks of each 4-week cycle) with individual dose adjustment depending on toxicity were retrospectively identified.

Prognostic value of pre-irradiation FET PET in patients with not completely resectable IDH-wildtype glioma and minimal or absent contrast enhancement.

In glioma patients, complete resection of the contrast-enhancing portion is associated with improved survival, which, however, cannot be achieved in a considerable number of patients. Here, we evaluated the prognostic value of O-(2-[F]-fluoroethyl)-L-tyrosine (FET) PET in not completely resectable glioma patients with minimal or absent contrast enhancement before temozolomide chemoradiation. Dynamic FET PET scans were performed in 18 newly diagnosed patients with partially resected (n = 8) or biopsied (n = 10) IDH-wildtype astrocytic glioma before initiation of temozolomide chemoradiation.

Leptomeningeal Carcinomatosis in a Patient with Pancreatic Cancer Responding to Nab-Paclitaxel plus Gemcitabine.

Leptomeningeal carcinomatosis is an extremely rare, but devastating complication in pancreatic cancer patients with a poor prognosis despite multimodal treatment. We present a 51-year-old male patient with the very rare condition of leptomeningeal carcinomatosis originating from pancreatic cancer. He presented to our hospital with severe headache and neck stiffness 30 months after systemic chemotherapy.