Abstract
BackgroundGlioblastoma multiform (GBM), a malignant brain tumour, has a very often poor prognosis. The therapeutic approach is represented by surgery followed by radiotherapy and chemotherapy. Hypoxia is a factor that causes a reduction of both radiotherapy and chemotherapy effectiveness in GBM and other cancers. Through the use of [64Cu][Cu(ATSM)], a hypoxia-targeting positron emission tomography (PET) radiotracer, is possible to identify the presence of hypoxic areas within a lesion and therefore modulate the therapeutic approach according to the findings.Case presentationIn this case report, we observed an increase of radiotracer uptake from early acquisition to late acquisition in hypoxia sites and high correlation between [64Cu][Cu(ATSM) PET/CT results and expression of the hypoxia marker HIF-1α.Conclusions[64Cu][Cu(ATSM) PET/CT represents a valid opportunity to reveal in vivo hypoxic areas in GBM lesion which can guide clinicians on selecting GMB patient’s therapeutic scheme.
Highlights
Glioblastoma multiform (GBM), a malignant brain tumour, has a very often poor prognosis
GBM is a very aggressive tumour which has a poor prognosis, standard therapeutic strategy includes a radical surgical removal of glioma combined with radio- and chemo-therapy
The effectiveness of radiotherapy and chemotherapy is compromised by the presence of hypoxia [8]
Summary
Glioblastoma multiform (GBM) cases represent about 16% of all primary brain tumours in adults and 54% of the total anaplastic gliomas [1]. We present a case of a GBM patient who underwent a [64Cu][Cu(ATSM)] PET/CT study before surgery, the pathological tissue following surgery was subjected to histological and HIF-1α immunohistochemical staining. On July 12th of 2016, the examination [64Cu][Cu(ATSM)] PET/CT brain images showed “pathological accumulation of the radiopharmaceutical at the level of right temporopolar brain region; in particular the qualitative increment of tracer uptake from early to late scan was evident and sustained by a progressive increase of SUVmax with time, reaching a peak SUVmax value at approximately 18 h after initial [64Cu][Cu(ATSM)] administration (SUVmax of 3.2, 4.1 and 4.9 at 1, 4 and 18 h, respectively, Fig. 1a-d). On July 15th of 2016, the patient underwent surgical removal of the right brain temporal lesion, tissues were subjected to histological and immunohistochemical analysis for HIF-1α expression. On July 23rd of 2016, the patient returned home with a residual spatial and temporal disorientation
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