title: Patients with recurrent glioblastoma multiforme. Initial experience with p-[(131)I]iodo-L-phenylalanine and external beam radiation therapy.
abstract: OBJECTIVE
  The objective of this study was to assess the feasibility, dosimetry, tolerability and efficacy of systemically administrated p-[(131)I]iodo-L-phenylalanine ((131)IPA) combined with hypo-fractionated external beam radiation therapy (EBRT) in patients with recurrent glioblastoma multiforme (GBM).
  
  
  METHODS
  Five patients (2 women, 3 men, aged 27-69) with recurrent GBM and exhaustion of regular therapy options were included. All had a positive O-(2-[(18)F]Fluoroethyl)-L-tyrosine positron emission tomography (FET-PET) and pretherapeutic dosimetry was performed. Tumour targeting was verified by (131)IPA-SPECT up to six days after radiotracer administration. After (131)IPA therapy, patients were treated with hypo-fractionated EBRT in six fractions of 5 Gy (n = 4) or in eleven fractions of 2 Gy in one case.
  
  
  RESULTS
  Based on the individual dosimetry, the patients received a single intravenous administration of 2 to 7 GBq of (131)IPA, resulting in radiation absorbed doses to the blood of 0.80-1.47 Gy. The treatment was well tolerated; only minor complaints of nausea and vomiting that responded to ondansetron and pantoprazol were noticed in the first two patients. After preventive medication, the last three patients had no complaints during therapy. In none of the patients a decrease of leukocyte or thrombocyte counts below the baseline level or the lower normal limit was observed. Tumour doses from (131)IPA were low (≤ 1 Gy) and all patients died three to eight (median 5.5) months after therapy.
  
  
  CONCLUSIONS
  In this initial experience, treatment of GBM with (131)IPA in combination with EBRT was demonstrated to be safe and well tolerated, but less effective than suggested by the animal studies.
authors.affiliation: Department of Nuclear Medicine, University of Würzburg, Germany. fverburg@ukaachen.de
authors.forename: F A
authors.initials: FA
authors.lastname: Verburg
authors.forename: R
authors.initials: R
authors.lastname: Sweeney
authors.forename: H
authors.initials: H
authors.lastname: Hänscheid
authors.forename: S
authors.initials: S
authors.lastname: Dießl
authors.forename: I
authors.initials: I
authors.lastname: Israel
authors.forename: M
authors.initials: M
authors.lastname: Löhr
authors.forename: G H
authors.initials: GH
authors.lastname: Vince
authors.forename: M
authors.initials: M
authors.lastname: Flentje
authors.forename: C
authors.initials: C
authors.lastname: Reiners
authors.forename: S
authors.initials: S
authors.lastname: Samnick
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D010649:Phenylalanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010865:Pilot Projects; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D010649:Phenylalanine; C049181:4-iodophenylalanine