Prather Kiana Y, O'Neal Christen M, Westrup Alison M, Tullos Hurtis J, Hughes Kendall L, Conner Andrew K, Glenn Chad A, Battiste James D
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Neurooncol Adv. 2022 Feb 13;4(1):vdac008. doi: 10.1093/noajnl/vdac008. eCollection 2022 Jan-Dec.
The response assessment in neuro-oncology (RANO) criteria have been the gold standard for monitoring treatment response in glioblastoma (GBM) and differentiating tumor progression from pseudoprogression. While the RANO criteria have played a key role in detecting early tumor progression, their ability to identify pseudoprogression is limited by post-treatment damage to the blood-brain barrier (BBB), which often leads to contrast enhancement on MRI and correlates poorly to tumor status. Amino acid positron emission tomography (AA PET) is a rapidly growing imaging modality in neuro-oncology. While contrast-enhanced MRI relies on leaky vascularity or a compromised BBB for delivery of contrast agents, amino acid tracers can cross the BBB, making AA PET particularly well-suited for monitoring treatment response and diagnosing pseudoprogression. The authors performed a systematic review of PubMed, MEDLINE, and Embase through December 2021 with the search terms "temozolomide" OR "Temodar," "glioma" OR "glioblastoma," "PET," and "amino acid." There were 19 studies meeting inclusion criteria. Thirteen studies utilized [F]FET, five utilized [C]MET, and one utilized both. All studies used static AA PET parameters to evaluate TMZ treatment in glioma patients, with nine using dynamic tracer parameters in addition. Throughout these studies, AA PET demonstrated utility in TMZ treatment monitoring and predicting patient survival.
神经肿瘤学中的反应评估（RANO）标准一直是监测胶质母细胞瘤（GBM）治疗反应以及区分肿瘤进展与假性进展的金标准。虽然RANO标准在检测早期肿瘤进展方面发挥了关键作用，但其识别假性进展的能力受到血脑屏障（BBB）治疗后损伤的限制，这通常会导致MRI上的对比增强，且与肿瘤状态的相关性较差。氨基酸正电子发射断层扫描（AA PET）是神经肿瘤学中一种迅速发展的成像方式。对比增强MRI依赖于血管渗漏或受损的血脑屏障来输送造影剂，而氨基酸示踪剂可以穿过血脑屏障，这使得AA PET特别适合监测治疗反应和诊断假性进展。作者通过检索词“替莫唑胺”或“泰道”、“胶质瘤”或“胶质母细胞瘤”、“PET”和“氨基酸”，对截至2021年12月的PubMed、MEDLINE和Embase进行了系统综述。有19项研究符合纳入标准。13项研究使用了[F]FET，五项使用了[C]MET，一项同时使用了两者。所有研究均使用静态AA PET参数评估胶质瘤患者的替莫唑胺治疗，另外有九项研究使用了动态示踪剂参数。在这些研究中，AA PET在替莫唑胺治疗监测和预测患者生存方面均显示出效用。
