Abstract
Object
The object was to study the value of postoperative positron emission tomography (PET) to assess the extension of brain tumor resection.
Methods
Twenty children operated on for total resection of a glial tumor (18 low-grade, 2 anaplastic) presented a signal on postoperative magnetic resonance (MR) images raising the question of a possible tumor residue. PET was performed early (18F-Fluoro-deoxyglucose in 1, 11C-methionine in 16, both in 3) to further characterize the nature of the abnormal MR signal in order to consider second-look surgery. An increased tracer uptake found in 14 children led to reoperation on 11 of them, confirming the tumor histologically. No 11C-methionine uptake led to a conservative attitude in 6 children in whom MR imaging follow-up showed no tumor progression.
Conclusions
The early postoperative PET, especially with 11C-methionine, appears to be a valid basis for complementary therapeutic decisions, especially second-look surgery, in glial tumors for which a radical resection is a key factor for prognosis.
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References
Albright AL (1993) Pediatric brain tumors. CA Cancer J Clin 43:272–288
Bowers DC, Krause TP, Aronson LJ, Barzi A, Burger PC, Carson BS, Weingart JD, Wharam MD, Melhem ER, Cohen KJ (2001) Second surgery for recurrent pilocytic astrocytoma in children. Pediatr Neurosurg 34:229–234
Connolly LP, Drubach LA, Ted Treves S (2002) Applications of nuclear medicine in pediatric oncology. Clin Nucl Med 27:117–125
Essig M, Metzner R, Bonsanto M, Hawighorst H, Debus J, Tronnier V, Knopp MV, van Kaick G (2001) Postoperative fluid-attenuated inversion recovery MR imaging of cerebral gliomas: initial results. Eur Radiol 11:2004–2010
Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237–250
Foreman NK, Love S, Gill SS, Coakham HB (1997) Second-look surgery for incompletely resected fourth ventricle ependymomas: technical case report. Neurosurgery 40:856–860
Goldman S, Levivier M, Pirotte B, Brucher JM (1996) Regional glucose metabolism and histiopathology of gliomas. A study based on PET-guided stereotactic biopsy. Cancer 78:1098–1106
Goldman S, Levivier M, Pirotte B, Brucher JM, Wikler D, Damhaut P, Dethy S, Brotchi J, Hildebrand J (1997) Regional methionine and glucose uptake in high-grade gliomas: a comparative study on PET-guided stereotactic biopsy. J Nucl Med 38:1–4
Hoffman JM, Hanson MW, Friedman HS, Hockenberger BM, Oakes WJ, Halperin EC, Coleman RE (1992) FDG-PET in pediatric posterior fossa brain tumors. J Comput Assist Tomogr 16:62–68
Kaplan AM, Bandy DJ, Manwaring KH, Chen K, Lawson MA, Moss SD, Duncan JD, Wodrich DL, Schnur JA, Reiman EM (1999) Functional brain mapping using positron emission tomography scanning in preoperative neurosurgical planning for pediatric brain tumors. J Neurosurg 91:797–803
Khan RB, Sanford RA, Kun LE, Thompson SJ (2001) Morbidity of second-look surgery in pediatric central nervous system tumors. Pediatr Neurosurg 35:225–229
Kleihues P, Burger PC, Scheithauer BW (1993) The new WHO classification of brain tumors. Brain Pathol 3:255–268
Levivier M, Wikier D, Goldman S, David P, Metens T, Massager N, Gerosa M, Devriendt D, Desmedt F, Simon S, Van Houtte P, Brotchi J (2000) Integration of the metabolic data of PET in the dosimetry planning of radiosurgery with the gamma knife: early experience with brain tumors. J Neurosurg 93:233–238
Mason WP, Grovas A, Halpern S, Dunkel IJ, Garvin J, Heller G, Rosenblum M, Gardner S, Lyden D, Sands S, Puccetti D, Lindsley K, Merchant TE, O’Malley B, Bayer L, Petriccione MM, Allen J, Finlay JL (1998) Intensive chemotherapy and bone marrow rescue for young children with newly diagnosed malignant brain tumors. J Clin Oncol 16:210–221
Oser AB, Moran CJ, Kaufman BA, Park TS (1997) Intracranial tumor in children: MR imaging findings within 24 hours of craniotomy. Radiology 205:807–812
Paulino AC, Wen BC, Buatti JM, Hussey DH, Zhen WK, Mayr NA, Menezes AH (2002) Intracranial ependymomas: an analysis of prognostic factors and patterns of failure. Am J Clin Oncol 25:117–122
Pirotte B, Goldman S, David P, Wikler D, Damhaut P, Vandesteene A, Salmon L, Brotchi J, Levivier M (1997) Stereotactic brain biopsy guided by positron emission tomography (PET) with [F-18]fluorodeoxyglucose and [C-11]methionine. Acta Neurochir (Wien) 68 [Suppl]:133–138
Pirotte B, Goldman S, Salzberg S, Wikler D, David P, Vandesteene A, Van Bogaert P, Salmon I, Brotchi J, Levivier M (2003) Combined positron emission tomography and magnetic resonance imaging for the planning of stereotactic brain biopsies in children: experience in 9 cases. Pediatr Neurosurg 38:146–155
Pollack IF (1999) The role of surgery in pediatric gliomas. J Neurooncol 42:271–288
Utriainen M, Metsahonkala L, Salmi TT, Utriainen T, Kalimo H, Pihko H, Makipernaa A, Harila-Saari A, Jyrkkio S, Laine J, Nagren K, Minn H (2002) Metabolic characterization of childhood brain tumors: comparison of 18F-fluorodeoxyglucose and 11C-methionine positron emission tomography. Cancer 95:1376–1386
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Pirotte, B., Levivier, M., Morelli, D. et al. Positron emission tomography for the early postsurgical evaluation of pediatric brain tumors. Childs Nerv Syst 21, 294–300 (2005). https://doi.org/10.1007/s00381-004-1071-7
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DOI: https://doi.org/10.1007/s00381-004-1071-7