Abstract
The present study evaluated usefulness of the positron emission tomography with 11C-methionine for prediction of the clinical course and treatment decision-making in adult patients with newly diagnosed non-enhancing brain lesions mimicking low-grade gliomas. Retrospective analysis was done in 163 cases. In overall, 131 tumors underwent surgical resection, which in 34 cases was done after initial period of observation. Among the latter 5 patients were operated on after significant clinical deterioration. In overall, 3 resected neoplasms corresponded to WHO histopathological grade I, 87 to grade II, 39 to grade III, and 2 to grade IV. In all 163 cases the tumor/normal brain uptake ratio (T/N ratio) of 11C-methionine ranged from 0.68 to 8.02 (mean 2.21 ± 1.16, median 1.81). Mean T/N ratios of non-operated lesions, low-grade and high-grade tumors were 1.60 ± 0.85, 2.27 ± 1.22, and 2.54 ± 1.09, respectively (P < 0.0001), but overlap between 3 groups was prominent. In patients who had clinical deterioration during the period of observation T/N ratios of the lesion varied from 1.49 to 3.38 (mean 2.23 ± 0.70, median 2.15). Comparison of the deterioration-free survival of patients with T/N ratios of the lesion above and below 1.90 revealed statistically significant difference (P < 0.0001). In conclusion, “wait-and-scan” strategy with delay of surgical treatment does not seem reasonable option if T/N ratio of 11C-methionine in the non-enhancing glioma-like brain lesion constitutes ≥1.90, since it may be associated with significant risk of tumor progression and clinical deterioration during follow-up.
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Acknowledgments
The authors are thankful to Drs. Tatsuki Aki, Soko Ikuta, Takayuki Kato, Osami Kubo, Kazuhiro Miwa, Noriyuki Nakayama, Naoki Oka, Shunsuke Takenaka, Shingo Yonezawa, and Mikhail Chernov for their help during the study and manuscript preparation.
Grant support
This study was supported by grants from the Japan National Cancer Research and Development Fund and Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Agency.
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Watanabe, A., Muragaki, Y., Maruyama, T. et al. Usefulness of 11C-methionine positron emission tomography for treatment-decision making in cases of non-enhancing glioma-like brain lesions. J Neurooncol 126, 577–583 (2016). https://doi.org/10.1007/s11060-015-2004-x
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DOI: https://doi.org/10.1007/s11060-015-2004-x