Availability and use of PET in patients with brain tumours - a European Organisation for Research and Treatment of Cancer - Brain Tumour Group (EORTC-BTG) survey.

in European journal of nuclear medicine and molecular imaging by Maximilian J Mair, Philipp Lohmann, Norbert Galldiks, Mattias Belting, Petter Brandal, Martinus P G Broen, Francesco Cicone, Jean-François Daisne, François Ducray, Felix Ehret, Julia Furtner, Asgeir S Jakola, Maximilian Niyazi, Alessia Pellerino, Marika Rasschaert, Evangelia Razis, Felix Sahm, Marion Smits, Nelleke Tolboom, Antoine Verger, Emilie Le Rhun, Giuseppe Minniti, Michael Weller, Matthias Preusser, Nathalie L Albert

TLDR

  • A cross-sectional online survey of 103 European institutions found variable PET use in neuro-oncology, with limited availability of tracers and high cost being major barriers.

Abstract

Positron emission tomography (PET) is increasingly used in neuro-oncology. However, little is known about its application across European institutions and reasons for variable implementation. Between June and August 2024, members of the European Organisation for Research and Treatment of Cancer - Brain Tumour Group (EORTC-BTG) completed a cross-sectional online survey on PET use in neuro-oncological practice. Overall, 103 replies from 20 countries were received. A PET facility was available at 96/103 (93.2%) sites, of whom 74 (77.1%) performed PET in patients with brain tumours. Reasons for not performing PET included limited availability of tracers (14/29, 48.3%), high cost (11/29, 37.9%), and PET perceived unnecessary (8/29, 27.6%). Of sites performing PET, 69/74 (93.2%) reported use in glioma, 58/74 (78.4%) in brain metastasis, 52/74 (70.3%) in meningioma, and 46/74 (62.2%) in CNS lymphoma. Amino acid PET was performed at 62/71 centres (87.3%; 3 not reported [n.r.]), most frequently in glioma (58/59, 98.3%, 3 n.r.) and for differentiation of treatment-related changes from tumour progression (58/59, 98.3%). Somatostatin receptor (SSTR) PET was performed at 50/68 sites (73.5%, 6 n.r.), mainly in meningioma (48/49, 98.0%), for patient selection before radioligand therapy (41/49, 83.7%) and for radiotherapy target volume definition (33/49, 67.3%). Unrestricted coverage by statutory health insurance was reported by 46/59 (78.0%) centres for amino acid PET and 33/49 (67.3%) for SSTR PET. PET use in neuro-oncology is variable across EORTC-BTG sites. Generation of evidence in clinical trials and surveys including non-academic institutions are needed to guide implementation in clinical practice.

Overview

  • The study aimed to investigate PET use in neuro-oncological practice across European institutions and identify reasons for variable implementation.
  • A cross-sectional online survey was conducted among members of the European Organisation for Research and Treatment of Cancer - Brain Tumour Group (EORTC-BTG) between June and August 2024, receiving 103 replies from 20 countries.
  • The primary objective of the study was to understand the current use of PET in neuro-oncology and identify potential barriers to its implementation in clinical practice.

Comparative Analysis & Findings

  • A PET facility was available at 96/103 (93.2%) sites, with 74 (77.1%) of these sites performing PET in patients with brain tumours.
  • Reasons for not performing PET included limited availability of tracers (14/29, 48.3%), high cost (11/29, 37.9%), and PET perceived as unnecessary (8/29, 27.6%).
  • Of sites performing PET, amino acid PET was performed at 62/71 centres (87.3%), most frequently in glioma (58/59, 98.3%), and somatostatin receptor (SSTR) PET was performed at 50/68 sites (73.5%).

Implications and Future Directions

  • The study highlights the need for evidence generation in clinical trials and surveys that include non-academic institutions to guide implementation of PET in clinical practice.
  • Unrestricted coverage by statutory health insurance was reported by 46/59 (78.0%) centres for amino acid PET and 33/49 (67.3%) for SSTR PET, which may impact the implementation of thesePET modalities.
  • Future research could explore the impact of PET use on patient outcomes, and investigate the perceived barriers to its implementation in clinical practice.
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