18F-Fluciclovine PET to distinguish treatment-related effects from disease progression in recurrent glioblastoma: PET fusion with MRI guides neurosurgical sampling.

Differentiation of true tumor progression from treatment-related effects remains a major unmet need in caring for patients with glioblastoma. Here, we report how the intraoperative combination of MRI with18F-fluciclovine PET guided surgical sampling in 2 patients with recurrent glioblastoma. 18F-Fluciclovine PET is FDA approved for use in prostate cancer and carries an orphan drug designation in glioma. To investigate its utility in recurrent glioblastoma, we fused PET and MRI images using 2 different surgical navigation systems and performed targeted stereotactic biopsies from the areas of high ("hot") and low ("cold") radiotracer uptake. Concordant histopathologic and imaging findings suggest that a combined18F-fluciclovine PET-MRI-guided approach can guide neurosurgical resection of viable recurrent glioblastoma in the background of treatment-related effects, which can otherwise look similar on MRI.

Neuro-oncology practice. 2019 Dec 08 [Epub]

Fraser Henderson, Steven Brem, Donald M O'Rourke, MacLean Nasrallah, Vivek P Buch, Anthony J Young, Robert K Doot, Austin Pantel, Arati Desai, Stephen J Bagley, S Ali Nabavizadeh

Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia., Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia., Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia., Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia.