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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

Published on Monday, 14 July 2025

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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About this publication.

The Di Bella's Method: Use of Somatostatin/Octreotide analogues and/or derivatives with pseudo-Metronomic Chemotherapy Cyclophosphamide and/or Hydroxyurea (together with others chemical compounds) in Head/Neck Cancer, Brain tumour, Glioblastoma and Neuroblastoma:

- The Di Bella Method DBM improved survival objective response and performance status in a retrospective observational clinical study on 23 tumours of the head and neck;

- A retrospective observational study on cases of anaplastic brain tumors treated with the Di Bella Method: A rationale and effectiveness;

- Recurrent Glioblastoma Multiforme (grade IV – WHO 2007): a case of complete objective response achieved by means of the concomitant administration of Somatostatin and Octreotide – Retinoids – Vitamin E – Vitamin D3 – Vitamin C – Melatonin – D2 R agonists (Di Bella Method – DBM) associated with Temozolomide;

- Neuroblastoma: Complete objective response to biological treatment;

- The Di Bella Method (A Fixed Part - Somatostatin, Octreotide, Sandostatin LAR, analogues and/or derivatives);

- Somatostatin in oncology, the overlooked evidences - In vitro, review and in vivo publications;

- Publication, 2018 Jul: Over-Expression of GH/GHR in Breast Cancer and Oncosuppressor Role of Somatostatin as a Physiological Inhibitor (from Di Bella's Foundation);

- Publication, 2018 Sep: The over-expression of GH/GHR in tumour tissues with respect to healthy ones confirms its oncogenic role and the consequent oncosuppressor role of its physiological inhibitor, somatostatin: a review of the literature (from Di Bella's Foundation);

- Publication, 2019 Aug: The Entrapment of Somatostatin in a Lipid Formulation: Retarded Release and Free Radical Reactivity (from Di Bella's Foundation);

- Publication, 2019 Sep: Effects of Somatostatin and Vitamin C on the Fatty Acid Profile of Breast Cancer Cell Membranes (from Di Bella's Foundation);

- Publication, 2019 Sep: Effects of somatostatin, curcumin, and quercetin on the fatty acid profile of breast cancer cell membranes (from Di Bella's Foundation);

- Publication, 2020 Sep: Two neuroendocrine G protein-coupled receptor molecules, somatostatin and melatonin: Physiology of signal transduction and therapeutic perspectives (from Di Bella's Foundation);

- The Di Bella Method (A Fixed Part - Cyclophosphamide 50mg tablets and/or Hydroxyurea 500mg tablets, one or two per day);

- The Di Bella Method (A Fixed Part - Bromocriptine and/or Cabergoline);

- Prolactin inhibitors in oncology - In vitro, review and in vivo publications;

The Di Bella's Method: Use of Somatostatin/Octreotide analogues and/or derivatives since 1977 with Cabergoline and/or Bromocriptine associated with pseudo-Metronomic Chemotherapy Cyclophosphamide and/or Hydroxyurea - together with others chemical compounds - in several Oncological Pathologies:

- Chronic Lymphocytic Leukemia: Long-Lasting Remission with Combination of Cyclophosphamide, Somatostatin, Bromocriptine, Retinoids, Melatonin, and ACTH;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in advanced non-small-cell lung cancer patients with low performance status;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in chemotherapy-pretreated patients with advanced lung adenocarcinoma and low performance status;

- Observations on the Report of a case of pulmonary adenocarcinoma with lymph node, hepatic and osseus metastasis;

- Pleural Mesothelioma: clinical records on 11 patients treated with Di Bella's Method;

- Malignant pleural mesothelioma, stage T3-T4. Consideration of a case study;

- Excellent result in a Mesothelioma case treated exclusively with Di Bella Method for over 4 years and still treatment with positive results;

- A case of advanced Multiple Myeloma treated with Di Bella Method (DBM) into total remission for 13 years;

- Cyclophosphamide plus Somatostatin, Bromocriptin, Retinoids, Melatonin and ACTH in the Treatment of Low-grade Non-Hodgkin’s Lymphomas at Advanced Stage: Results of a Phase II Trial;

- Relapse of High-Grade Non-Hodgkin’s Lymphoma After Autologous Stem Cell Transplantation: A Case Successfully Treated With Cyclophosphamide Plus Somatostatin, Bromocriptine, Melatonin, Retinoids, and ACTH;

- Low-grade Non-Hodgkin Lymphoma at Advanced Stage: A Case Successfully Treated With Cyclophosphamide Plus Somatostatin, Bromocriptine, Retinoids, and Melatonin;

- The Di Bella Method (DBM) improved survival, objective response and performance status in a retrospective observational clinical study on 55 cases of Lymphomas;