Abstract
In the treatment of patients suffering from malignant glioma, it is a paramount importance to deliver a high radiation dose to the tumor on the one hand and to spare organs at risk at one the other in order to achieve a sufficient tumor control and to avoid severe side effects. New radiation therapy techniques have emerged like intensity modulated radiotherapy and image guided radiotherapy that help facilitate this aim. In addition, there are advanced imaging techniques like Positron emission tomography (PET) and PET/CT which can help localize the tumor with higher sensitivity, and thus contribute to therapy planning, tumor control, and follow-up. During follow-up care, it is crucial to differentiate between recurrence and treatment-associated, unspecific lesions, like radiation necrosis. Here, too, PET/CT can facilitate in differentiating tumor relapse from unspecific changes. This review article will discuss therapy response criteria according to the current imaging methods like Magnet resonance imaging, CT, and PET/CT. It will focus on the significance of PET in the clinical management for treatment and follow-up.
Highlights
Positron emission tomography has become an important imaging technique to improve the definition of the target volume for irradiation and to decrease the inter-observer variability (Grosu et al., 2005a)
Positron emission tomography is more and more established Combination of PET and MRI imaging into one study as imaging tool in assessment of treatment response, recurrence, (PET/MRI) could further improve patient care and facilitate and follow-up of malignant glioma patients
Summary
Positron emission tomography (PET) is a functional imaging method that has gained widespread use in the assessment of brain tumors. PET-tracers currently used for imaging of brain tumors are mostly radio labeled amino acid (AA) tracers. These AA are preferentially taken up by tumor cells (Derlon et al, 1989; Heiss et al, 1999; Grosu et al, 2011) due to an overexpression of amino acid transporters, while the uptake of the normal brain tissue is relatively low. [18F]3 -deoxy-3 -fluorothymidine (FLT), a nucleoside, shows an increased expression of thymidine kinase and cell proliferation (Ullrich et al, 2008) and correlates with Ki-67 It allows a non-invasive assessment of tumor proliferation as well as early response to chemotherapy by PET (Jacobs et al, 2005). 18F-fluoromisonidazole (18F-FMISO) has the ability to visualize the hypoxic cell fraction of tissue (Cher et al, 2006) and makes www.frontiersin.org
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