Impact of 3,4-dihydroxy-6-18F-fluoro-L-phenylalanine PET/CT on managing patients with brain tumors: the referring physician's perspective.
We investigated the impact of (18)F-DOPA brain PET/CT on the clinical management of patients with known or suspected brain tumors.


METHODS
A prospective survey of referring physicians was conducted. A pre-PET questionnaire inquired about indication, tumor histology or grade, level of suspicion for tumor recurrence, and planned management. Early post-PET questionnaires asked referring physicians to categorize PET findings as negative, equivocal, or positive; assessed the level of suspicion for primary or recurrent brain tumor; and recorded intended management changes prompted by PET findings. A late follow-up questionnaire 6 mo after the scan aimed at determining patient outcome (recurrence, survival). In addition, all referring physicians were contacted to determine whether management changes intended after (18)F-DOPA PET/CT were implemented.


RESULTS
Fifty-eight consecutive patients were included. The clinical suspicion for recurrence increased in 33%, remained unchanged in 50%, and decreased in 17% of patients after adding the PET/CT result to the available diagnostic data. The late post-PET questionnaire confirmed recurrence in 26 patients whereas 32 had stable disease or remained disease-free. (18)F-DOPA PET/CT resulted in intended management changes in 41% of patients. Changes in intended management from wait and watch to chemotherapy (6 patients [25%]) and from chemotherapy to wait and watch (4 patients [17%]) occurred most frequently. Clinical follow-up revealed that 75% of intended treatment changes were implemented.


CONCLUSIONS
(18)F-DOPA PET/CT changed the intended management of 41% of patients with brain tumors, and intended management changes were implemented in 75% of these. These changes suggest a potentially important clinical role of imaging amino acid transport in the management of brain tumor patients.
Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, CA, USA.
Franziska
F
Walter
Timothy
T
Cloughesy
Martin A
MA
Walter
Albert
A
Lai
Phioanh
P
Nghiemphu
Naveed
N
Wagle
Barbara
B
Fueger
Nagichettiar
N
Satyamurthy
Michael E
ME
Phelps
Johannes
J
Czernin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001254:Astrocytoma / Q000000981:diagnostic imaging* / Q000628:therapy; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D009837:Oligodendroglioma / Q000000981:diagnostic imaging* / Q000628:therapy; D010346:Patient Care Management; D010820:Physicians; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D019275:Radiopharmaceuticals; C043437:fluorodopa F 18; D004295:Dihydroxyphenylalanine