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DOTATATE PET/MR Imaging Differentiates Secondary-Progressive from de Novo World Health Organization Grade 3
Joon Tae Kim1, Se Jung Chris Chang1, Arsalan Haghdel1
1From the Weill Cornell Medical College (J.T.K., S.J.C.C., A.H.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York.
Background And Purpose:
WHO grade 3 meningiomas are rare and poorly understood and have a higher propensity for recurrence, metastasis, and worsened clinical outcomes compared with lower-grade meningiomas. The purpose of our study was to prospectively evaluate the molecular profile, PET characteristics, and outcomes of patients with World Health Organization grade 3 meningiomas who were imaged with gallium 68 (68Ga) DOTATATE PET/MR imaging.
Materials And Methods:
Patients with World Health Organization grade 3 meningiomas enrolled in our prospective observational cohort evaluating the utility of (68Ga) DOTATATE PET/MR imaging in somatostatin receptor positive brain tumors were included. We stratified patients by de novo-versus-secondary-progressive status and evaluated the differences in the PET standard uptake value, molecular profiles, and clinical outcomes.
Results:
Patients met the inclusion criteria (secondary-progressive: 7/14; de novo: 7/14). The secondary-progressive cohort had a significantly higher per-patient number of surgeries (4.1 versus 1.6; P = .011) and trended toward a higher number of radiation therapy courses (2.4 versus 1.6; P = .23) and cumulative radiation therapy doses (106Gy versus 68.3Gy; P = .31). The secondary-progressive cohort had a significantly lower progression-free survival compared with the de novo cohort (4.8 versus 37.7 months; P = .004). Secondary-progressive tumors had distinct molecular pathology profiles with higher numbers of mutations (3.5 versus 1.2; P = .024). Secondary-progressive tumors demonstrated higher PET standard uptake values (17.1 versus 12.4; P = .0021).
Conclusions:
Our study confirms prior work illustrating distinct clinical outcomes in secondary-progressive and de novo World Health Organization grade 3 meningiomas. Furthermore, our findings support (68Ga) DOTATATE PET/MR imaging as a useful management strategy in World Health Organization grade 3 meningiomas and provide insight into meningioma biology, as well as clinical management implications.
Insights
WHO grade 3 meningiomas show distinct outcomes based on progression. Gallium 68 DOTATATE PET/MR imaging aids in managing these aggressive brain tumors and understanding their biology.
Area of Science:
- Neuro-oncology
- Molecular imaging
- Radiology
Background:
- World Health Organization (WHO) grade 3 meningiomas are rare, aggressive brain tumors with poor prognoses.
- These tumors exhibit higher recurrence, metastasis, and worse clinical outcomes than lower-grade meningiomas.
- Understanding their molecular profile and imaging characteristics is crucial for effective management.
Purpose of the Study:
- To prospectively evaluate the molecular profile, PET characteristics, and clinical outcomes of WHO grade 3 meningiomas.
- To assess the utility of gallium 68 (68Ga) DOTATATE PET/MR imaging in patients with these tumors.
- To compare de novo versus secondary-progressive WHO grade 3 meningiomas.
Main Methods:
- Prospective observational cohort study of patients with WHO grade 3 meningiomas.
- Utilized gallium 68 (68Ga) DOTATATE PET/MR imaging for all participants.
- Stratified patients into de novo and secondary-progressive groups for comparative analysis of PET SUV, molecular profiles, and clinical outcomes.
Main Results:
- Secondary-progressive meningiomas showed significantly more surgeries, higher PET standard uptake values (SUV), and distinct molecular profiles with more mutations compared to de novo.
- Progression-free survival was significantly lower in the secondary-progressive cohort (4.8 months) versus the de novo cohort (37.7 months).
- Significant differences (P < .05) were observed in per-patient surgeries and PET SUV between the two groups.
Conclusions:
- Confirms distinct clinical outcomes between secondary-progressive and de novo WHO grade 3 meningiomas.
- Supports the use of (68Ga) DOTATATE PET/MR imaging as a valuable management strategy for WHO grade 3 meningiomas.
- Provides insights into meningioma biology and clinical management implications.
