2025 Boron neutron capture therapy (BNCT) for glioblastoma multiforme (GBM), using the epithermal neutron beam at the Brookhaven national laboratory (original) (raw)
Related papers
Evaluation of brain tumor recurrence by 99mTc-tetrofosmin SPECT: a prospective pilot study
Annals of Nuclear Medicine, 2007
The differentiation between brain tumor recurrence and post-irradiation injury remains an imaging challenge. Computed tomography (CT) and magnetic resonance imaging (MRI) cannot always distinguish between the two. Although glioma cell line studies substantiated a plausible imaging superiority of (99m)Tc-tetrofosmin ((99m)Tc-TF) over other radiopharmaceuticals, little has been reported on its in vivo imaging properties. We assessed (99m)Tc-TF single-photon emission CT (SPECT) in cases where morphologic brain imaging was inconclusive between recurrence and radionecrosis. A total of 11 patients (7 men, 4 women) were evaluated. The initial diagnosis was glioblastoma multiforme (4), anaplastic astrocytoma (1), anaplastic oligodendroglioma (3), grade-II astrocytoma (2), and low-grade oligodendroglioma (1). All patients had been operated on and then received adjuvant external-beam radiotherapy. After a mean follow-up period of 25 months, there was clinical suspicion of recurrence, for which (99m)Tc-TF SPECT was performed. In 8/11 cases, an abnormally increased tracer uptake appeared in the region that CT and/or MRI indicated as suspicious; in half of these cases, recurrence was confirmed histologically after surgery and in the other four by growth of the lesion over a 6-month follow-up period, and clinical deterioration. The remaining 3/11 patients had faint tracer uptake in the suspicious region, compatible with radiation injury; these lesions remained morphologically unaltered in a mean 12-month follow-up period, with no clinical deterioration in the patient's condition, a course strongly favoring the diagnosis of radiation injury. Metabolic brain imaging by (99m)Tc-TF could offer useful information in the workup of treated brain tumors, where radiomorphologic findings between recurrence and radionecrosis are inconclusive.
European Journal of Nuclear Medicine and Molecular Imaging, 2004
The initial treatment of high-grade glioma often consists of surgery and radiation therapy. Chemotherapy is used in cases of recurrence or after incomplete surgery. Because of the many potential serious side-effects of chemotherapy, early tumour response evaluation is necessary to enable clinicians to adapt the treatment. However, response monitoring with computed tomography (CT) or magnetic resonance imaging (MRI) is often difficult. The aim of this study was to assess the value of repeated technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computerised tomography (SPECT) for this purpose. Fifteen patients with malignant glioma were investigated with MIBI SPECT. Imaging was performed 1 h after the intravenous injection of 555 MBq of 99mTc-MIBI, using a dedicated SPECT system (Tomomatic 564, Medimatic, Denmark). Overall, 57 investigations were performed. A MIBI uptake index was computed as the ratio of counts in the lesion to those in the contralateral regi...
Journal of Nuclear Medicine, 2010
99m Tc-tetrofosmin brain SPECT has been reported as a useful tool for the evaluation of glioma proliferation. In the present study, we set out to investigate the prognostic value of 99m Tctetrofosmin brain SPECT in patients with glioblastoma multiforme. Methods: We prospectively studied 18 patients (13 men, 5 women; mean age 6 SD, 60.8 6 7.79 y) who were operated on for glioblastoma multiforme. All patients underwent preoperative 99m Tc-tetrofosmin brain SPECT, and surgical excision was performed within a week after SPECT. All patients received postoperative radiotherapy and chemotherapy. Results: By calculating the lesion-to-normal (L/N) 99m Tc-tetrofosmin uptake ratio, we found that patients with an L/N ratio of more than 4.7 had significantly worse survival than did patients with an L/N ratio of 4.7 or less. Furthermore, patients with a Karnofsky Performance Score more than 90 had a significantly better survival rate. Although patients with near-total tumor resection who were younger than 60 y survived longer, the difference did not reach statistical significance. In the multivariate analysis, 99m Tc-tetrofosmin uptake and Karnofsky Performance Score were identified as factors with independent prognostic power. Conclusion: 99m Tc-tetrofosmin brain SPECT may be an independent prognostic factor in patients with glioblastoma multiforme. Further larger studies are needed to verify these results.
Influence of Glioma's Multidrug Resistance Phenotype on 99mTc-Tetrofosmin Uptake
Molecular Imaging and Biology, 2011
Multidrug resistance (MDR) remains a major obstacle to successful chemotherapeutic treatment of cancer. Several chemotherapeutic and radiopharmaceutical agents are substrates of the pumps encoded by the MDR genes, and therefore, their accumulation is prevented. We evaluated in vivo whether [(99m)Tc]tetrofosmin ((99m)Tc-TF) uptake is influenced by the MDR profile of gliomas. Eighteen patients with histologically confirmed glioma were included in the study. Brain single-photon emission computed tomography by (99m)Tc-TF was performed within a week prior to surgical excision, and the expression of MRP5 was assessed by immunohistochemistry. Radiotracer accumulation was assessed by a semiquantitative method, calculating the lesion-to-normal uptake ratio. Using Spearman's ρ analysis, we found no correlation between tracer uptake expressed as lesion-to-normal and MRP5 expression. There was a significant correlation between glioma aggressiveness as assessed by Ki-67/MIB-1 and MRP5 expression. The present data suggest that (99m)Tc-TF uptake is not influenced by glioma's MDR phenotype. Thus, (99m)Tc-TF constitutes a suitable radiotracer for imaging gliomas.
The Journal of Nuclear Medicine, 2010
99m Tc-tetrofosmin brain SPECT has been reported as a useful tool for the evaluation of glioma proliferation. In the present study, we set out to investigate the prognostic value of 99m Tctetrofosmin brain SPECT in patients with glioblastoma multiforme. Methods: We prospectively studied 18 patients (13 men, 5 women; mean age 6 SD, 60.8 6 7.79 y) who were operated on for glioblastoma multiforme. All patients underwent preoperative 99m Tc-tetrofosmin brain SPECT, and surgical excision was performed within a week after SPECT. All patients received postoperative radiotherapy and chemotherapy. Results: By calculating the lesion-to-normal (L/N) 99m Tc-tetrofosmin uptake ratio, we found that patients with an L/N ratio of more than 4.7 had significantly worse survival than did patients with an L/N ratio of 4.7 or less. Furthermore, patients with a Karnofsky Performance Score more than 90 had a significantly better survival rate. Although patients with near-total tumor resection who were younger than 60 y survived longer, the difference did not reach statistical significance. In the multivariate analysis, 99m Tc-tetrofosmin uptake and Karnofsky Performance Score were identified as factors with independent prognostic power. Conclusion: 99m Tc-tetrofosmin brain SPECT may be an independent prognostic factor in patients with glioblastoma multiforme. Further larger studies are needed to verify these results.
Neuro-oncology, 2010
OBJECTIVE: Multidrug resistance (MDR) remains a major obstacle to successful chemotherapeutic treatment of cancer and can be caused by overexpression of P-glycoprotein, the MDR1 gene product. P-glycoprotein (P-gp) recognizes several chemotherapeutic agents as a substrate and prevents their accumulation. Among them, both technetium-99-sestamibi and technetioum-99-tetrofosmin (99m Tc-TF) are single photon emission computed tomography tracers. 99m Tc-MIBI uptake has been proven in vitro and in vivo to inversely correlate with P-gp levels of tumors. In vitro studies have shown that 99m Tc-TF is influenced in a lesser degree from the P-gp expression, thus may be superior to 99m Tc-MIBI for brain tumor imaging. In the present study, we evaluated in vivo whether 99m Tc-TF uptake correlates with P-gp levels in gliomas. MATERIALS AND METHODS: Eighteen patients (10 males, 8 females, mean age 57.3 years) with histologically confirmed glioma were included in the study. There were 13 glioblastoma multiforme cases, 2 anaplastic astrocytomas, 2 anaplastic oligodendrogliomas, and 1 low grade astrocytoma. Brain SPECT by 99m Tc-TF was performed within a week prior to surgical excision and the expression of P-gp was assessed by immunohistochemistry. Radiotracer accumulation was assessed by a semiquantitative method of image analysis, calculating the lesion-to-normal (L/N) uptake ratio. RESULTS: The tracer uptake ranged from faint to profound (mean L/ N ¼ 8.2, range 1.8-20). The P-gp expression ranged from 0% to 45%. Using Spearman's rho analysis we found no correlation between tracer uptake (L/ N) and P-gp expression (P ¼ .21, r ¼ .538). CONCLUSION: The present data suggest that 99m Tc-TF uptake is not influenced by P-gp expression in gliomas. Thus, 99m Tc-TF constitute a suitable radiotracer for gliomas imaging.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2004
This prospective clinical study used (99m)Tc-sestamibi (MIBI) brain SPECT to assess residual tumor volume and determine whether it would be prognostic of survival at the end of cranial irradiation in patients with malignant glioma. Fifty-seven patients with supratentorial malignant glioma were included in this clinical trial. Tomoscintigraphy was performed 4 h after an intravenous injection of MIBI (1,110 MBq). The images were obtained from a dual-head gamma-camera using fanbeam collimators. Transverse, coronal, and sagittal views were reconstructed. Metabolic tumor volume (MTV), using an ellipsoid model, was calculated from the 3 slices. The first posttherapeutic neuroradiologic evaluation was performed at the end of each patient's radiation therapy. (99m)Tc-MIBI brain SPECT performed at the end of cranial irradiation provided data that allowed the identification of residual tumor and could be used to accurately predict survival of malignant glioma patients, taking into account...