Role of PET Imaging in Patients with High-Grade Gliomas undergoing anti-angiogenic Therapy with Bevacizumab – Review of the Literature and Case Report

European Association of NeuroOncology Magazine 2014; 4 (3): 102-108

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Keywords: 18F-FDG,  18F-FET,  18F-FLT,  Bevacizumab,  PET,  therapy monitoring

Despite recent advantages in combination therapies the prognosis of high-grade gliomas remains very poor. A new therapeutic concept in the treatment of brain tumours uses the anti-angiogenic drug bevacizumab to reduce tumour neovascularisation. However, due to a concomitant reduction of contrast agent enhancement in MRI, imaging modalities that do not depend on a disruption of the blood-brain barrier (BBB) would be desirable for therapy monitoring. Positron emission tomography (PET) imaging has emerged as a promising tool for better assessment of treatment response in patients undergoing anti-angiogenic therapy compared to MRI. The most important tracers are amino acids like 11C-methionin and 18F-FET, but also 18F-FDG and 18F-FLT, a biomarker of cell proliferation. In this review, we provide an overview of current knowledge concerning the value of PET in patients with brain tumours undergoing anti-angiogenic therapy and present a clinical case that illustrates the utility of PET imaging.