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The trends and significance of SSTR PET/CT added to MRI in follow-up imaging of low-grade meningioma treated with fractionated proton therapy

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Abstract

Purpose

Overexpression of the somatostatin receptor (SSTR) has led to adoption of SSTR PET/CT for diagnosis and radiotherapy planning in meningioma, but data on SSTR expression during follow-up remain scarce. We investigated PET/CT quantifiers of SSTR tracers in WHO grade I meningioma following fractionated proton beam therapy (PBT) compared to standard response assessment with MRI.

Methods

Twenty-two patients diagnosed with low-grade meningioma treated by PBT were included. Follow-up included clinical visits, MRI, and [68Ga]Ga-DOTATOC PET/CT scans. Radiologic tumor response, MRI and PET volume (VMRI and VPET), maximum and mean standardied uptake value (SUVmax/SUVmean), total lesion activity (TLA), and heterogeneity index (HI) were evaluated.

Results

Median follow-up was 35.3 months (range: 6.4–47.9). Nineteen patients (86.4%, p = 0.0009) showed a decrease of SUVmax between baseline and first follow-up PET/CT (median: −24%, range: −53% to +89%) and in 81.8% of all cases, the SUVmax, SUVmean, and TLA at last follow-up were eventually lower than at baseline (p = 0.0043). Ambiguous trends without significance between the timepoints analyzed were observed for VPET. HI increased between baseline and last follow-up in 75% of cases (p = 0.024). All patients remained radiologically and clinically stable. Median VMRI decreased by −9.3% (range 0–32.5%, p < 0.0001) between baseline and last follow-up.

Conclusion

PET/CT in follow-up of irradiated meningioma showed an early trend towards decreased binding of SSTR-specific tracers following radiation and MRI demonstrated consistently stable or decreasing tumor volume. Translational research is needed to clarify the underlying biology of the subsequent increase in SSTR PET quantifiers.

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Acknowledgements

We thank Christoph Hajdusich for technical assistance, which made efficient revision of this article possible.

Author information

Authors and Affiliations

  1. MedAustron Ion Therapy Center, Marie Curie-Straße 5, 2700, Wiener Neustadt, Austria

    Carola Lütgendorf-Caucig, Maciej Pelak, Birgit Flechl, Petra Georg, Piero Fossati, Markus Stock, Gloria Zechmeister-Machhart, Lauritz Hermsmeyer & Eugen Hug

  2. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria

    Tatjana Traub-Weidinger

  3. Division of Palliative Care, Department of Internal Medicine 1, Medical University of Vienna, Vienna, Austria

    Christine Marosi

  4. Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria

    Christine Haberler

  5. Karl Landsteiner University of Health Sciences, Krems, Austria

    Gloria Zechmeister-Machhart & Lauritz Hermsmeyer

  6. Department of Nuclear Medicine, University Clinic St. Poelten, St. Poelten, Austria

    Anton Staudenherz

Authors
  1. Carola Lütgendorf-Caucig
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Contributions

All authors contributed to study conception and design. Material preparation, data collection, and analysis were performed by Carola Lütgendorf-Caucig, Gloria Zechmeister-Machhart, and Lauritz Hermsmeyer. Imaging data analysis was performed by Anton Staudenherz, Gloria Zechmeister-Machhart, and Lauritz Hermsmeyer. Acquisition of clinical data was performed by Carola Lütgendorf-Caucig, and Birgit Flechl. Statistical analysis was performed by Maciej Pelak. Discussion was written by Tatiana Traub-Weidinger, Christine Marosi, Christine Haberler, and Eugen Hug. The first draft of the manuscript was written by Carola Lütgendorf-Caucig and Maciej Pelak. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maciej Pelak.

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Conflict of interest

C. Lütgendorf-Caucig, M. Pelak, B. Flechl, P. Georg, P. Fossati, M. Stock, T. Traub-Weidinger, C. Marosi, C. Haberler, G. Zechmeister-Machhart, L. Hermsmeyer, E. Hug, and A. Staudenherz declare that they have no competing interests.

Ethical standards

Approval was obtained on 22.16.2016 from the regional ethics committee of Lower Austria, approval no. EK Nr GS1-EK-4/350-2015. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Written informed consent was obtained from all individual participants included in the study, including consent to publish anonymized data.

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Data availability

All source data were collected within a prospective registry study and, due to confidentiality, are available to certified trial auditors.

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Lütgendorf-Caucig, C., Pelak, M., Flechl, B. et al. The trends and significance of SSTR PET/CT added to MRI in follow-up imaging of low-grade meningioma treated with fractionated proton therapy. Strahlenther Onkol 199, 396–403 (2023). https://doi.org/10.1007/s00066-022-02010-4

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