Article
Impact of additional 18F-FET-PET imaging following immunotherapy with DC vaccination in GBM patients
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Authors
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Ann Kristin Schmitz
- Klinik für Neurochirurgie, Medizinische Fakultät, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
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Rüdiger Sorg
- Institut für Transplantationsdiagnostik und Zelltherapie, Medizinische Fakultät, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
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Oliver Grauer
- Klinik für Neurologie, Medizinische Fakultät, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
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Marcel Kamp
- Klinik für Neurochirurgie, Medizinische Fakultät, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
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Michael Sabel
- Klinik für Neurochirurgie, Medizinische Fakultät, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
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Karl-Josef Langen
- Forschungszentrum Jülich, Institut für Neurowissenschaften und Medizin (INM-), Medical Imaging Physics, Jülich, Deutschland
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Marion Rapp
- Klinik für Neurochirurgie, Medizinische Fakultät, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Vaccination therapy using autologous dendritic cells (DC) is a promising approach alongside standard treatment for Glioblastoma (GBM). However, large study groups with long-term surveillance are still missing and reliable best criteria regarding therapy monitoring are not established. Therefore, lately the RANO working group recommended modified observation periods and additional MRI scans according to varying MRI findings during immunotherapeutic treatment. Here, we retrospectively analysed the impact of additional 18F-FET PET imaging for the differentiation between tumor progression and therapy related changes following DC vaccination therapy.
Methods: We included in the following series (1) glioblastoma patients received additional vaccination therapy with autologous, mature, tumor- loaded dendritic cells, (2) underwent additional 18F-FET PET imaging as tumor recurrence was suspected and (3) were treated between 2003 to 2016 in our institution. Vaccination was performed weekly for six times by intradermal injections between concomitant radio/-chemotherapy and intermittent chemotherapy (weeks 6-10), or in relapse situations, before re-radiation therapy. MRI and 18F-FET PET results were compared and correlated with clinical data. Informed consent was given by the patients for these individual treatment schemes. Data are presented as mean ± standard error of mean.
Results: 7 patients were identified (2 female; mean age: 52 ± 10y). The progression-free survival was 7 ± 8 month after vaccination therapy. 4/7 patients showed congruent results of MRI and 18F-FET PET scans. Tumor progression was confirmed by neuropathological analysis or according to the RANO criteria. 18F-FET PET revealed reactive tissue in 3 patients: In one patient, histopathology identified massive necrosis with reactive changes confirming a response to vaccination therapy. In the second case, diagnosis was confirmed according to the RANO criteria and repeated MRIs. The third patient was lost of follow-up.
Conclusion: 18F-FET PET appears to be more accurate than contrast-enhanced MRI in distinguishing tumor recurrence from reactive changes following vaccination therapy in glioblastoma patients. The retrospective design, the small number of patients and the divergent diagnostic strategies limitsthis pilot study. However, it indicates a crucial role of 18F-FET PET for monitoring upcoming glioblastoma vaccination studies.
