Pub Date : 2022-06-01Epub Date: 2022-01-14DOI: 10.1055/a-1659-0010
Steven P Rowe, Andreas Buck, Ralph A Bundschuh, Constantin Lapa, Sebastian E Serfling, Thorsten Derlin, Takahiro Higuchi, Michael A Gorin, Martin G Pomper, Rudolf A Werner
Prostate-specific membrane antigen (PSMA)-directed positron emission tomography (PET) has gained increasing interest for imaging of men affected by prostate cancer (PC). In recent years, 68Ga-labeled PSMA compounds have been widely utilized, although there is a trend towards increased utilization of 18F-labeled agents. Among others, [18F]DCFPyL (piflufolastat F 18, PYLARIFY) has been tested in multiple major trials, such as OSPREY and CONDOR, which provided robust evidence on the clinical utility of this compound for staging, restaging, and change in management. Recent explorative prospective trials have also utilized [18F]DCFPyL PET/CT for response assessment, e.g., in patients under abiraterone or enzalutamide, rendering this 18F-labeled PSMA radiotracer as an attractive biomarker for image-guided strategies in men with PC. After recent approval by the U.S. Food and Drug Administration, one may expect more widespread use, not only in the U.S., but also in Europe in the long term. In the present review, we will provide an overview of the current clinical utility of [18F]DCFPyL in various clinical settings for men with PC.
{"title":"[18F]DCFPyL PET/CT for Imaging of Prostate Cancer.","authors":"Steven P Rowe, Andreas Buck, Ralph A Bundschuh, Constantin Lapa, Sebastian E Serfling, Thorsten Derlin, Takahiro Higuchi, Michael A Gorin, Martin G Pomper, Rudolf A Werner","doi":"10.1055/a-1659-0010","DOIUrl":"https://doi.org/10.1055/a-1659-0010","url":null,"abstract":"<p><p>Prostate-specific membrane antigen (PSMA)-directed positron emission tomography (PET) has gained increasing interest for imaging of men affected by prostate cancer (PC). In recent years, <sup>68</sup>Ga-labeled PSMA compounds have been widely utilized, although there is a trend towards increased utilization of <sup>18</sup>F-labeled agents. Among others, [<sup>18</sup>F]DCFPyL (piflufolastat F 18, PYLARIFY) has been tested in multiple major trials, such as OSPREY and CONDOR, which provided robust evidence on the clinical utility of this compound for staging, restaging, and change in management. Recent explorative prospective trials have also utilized [<sup>18</sup>F]DCFPyL PET/CT for response assessment, e.g., in patients under abiraterone or enzalutamide, rendering this <sup>18</sup>F-labeled PSMA radiotracer as an attractive biomarker for image-guided strategies in men with PC. After recent approval by the U.S. Food and Drug Administration, one may expect more widespread use, not only in the U.S., but also in Europe in the long term. In the present review, we will provide an overview of the current clinical utility of [<sup>18</sup>F]DCFPyL in various clinical settings for men with PC.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39911564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xue Zhang, H. Wakabayashi, Daiki Kayano, A. Inaki, S. Kinuya
AIM Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumours of chromaffin cells. Several modalities are currently available to treat patients with PPGL. These treatment modalities include surgery, chemotherapy, molecular targeted therapy and radiopharmaceuticals. METHODS I-131 metaiodobenzylguanidine (mIBG), a classic radiopharmaceutical, can be taken up through specific receptors and sited into many, but not all, PPGL cells. RESULTS Many studies have investigated the efficacy and toxicity of I-131 mIBG therapy. These studies reported significant results in terms of objective, hormonal and symptomatic responses as well as tolerable toxicities in patients. CONCLUSION This article reviews the reported experiences of patients who underwent I-131 mIBG therapy for PPGL with a focus on functions and deficiencies of the therapy.
{"title":"I-131 metaiodobenzylguanidine therapy is a significant treatment option for pheochromocytoma and paraganglioma.","authors":"Xue Zhang, H. Wakabayashi, Daiki Kayano, A. Inaki, S. Kinuya","doi":"10.1055/a-1759-2050","DOIUrl":"https://doi.org/10.1055/a-1759-2050","url":null,"abstract":"AIM\u0000Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumours of chromaffin cells. Several modalities are currently available to treat patients with PPGL. These treatment modalities include surgery, chemotherapy, molecular targeted therapy and radiopharmaceuticals.\u0000\u0000\u0000METHODS\u0000I-131 metaiodobenzylguanidine (mIBG), a classic radiopharmaceutical, can be taken up through specific receptors and sited into many, but not all, PPGL cells.\u0000\u0000\u0000RESULTS\u0000Many studies have investigated the efficacy and toxicity of I-131 mIBG therapy. These studies reported significant results in terms of objective, hormonal and symptomatic responses as well as tolerable toxicities in patients.\u0000\u0000\u0000CONCLUSION\u0000This article reviews the reported experiences of patients who underwent I-131 mIBG therapy for PPGL with a focus on functions and deficiencies of the therapy.","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78384216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Greek Mythology and Poetics is the second book in the Myth and Poetics series. My goal, as series editor, is to encourage work that will help integrate literary criticism with the approaches of anthropology and that will pay special attention to problems concerning the nexus of ritual and myth. For such an undertaking, we may look to the comparative testimony of relatively complex societies, such as the Ndembu of Zambia, and also of the very smallest, such as the Yukuna of the Colombian Amazon. 1 Just as important, we must pursue the varied testimonies of the most stratified societies, including those which go under the general heading "Western civilization." It is precisely here that the meaning of myth is the most misleading-and challenging. In a small-scale society myth tends to be viewed as the encoding of that society's concept of truth; at the same time, from the viewpoint of Western civilization, myth has become the opposite of fact, the antithesis of truth. 2 Since the ancient Greek concept of politeiii serves as the foundation for the very word "civilization" and for our concept of Western civilization, more than one of the books in this series will deal primarily with ancient Greece and the ancient Greek city-state, or polis. The testimony of the Greeks is particularly instructive with regard to our central concern, the relationship between ritual and myth. The very word "myth,"
{"title":"Foreword.","authors":"C. Lapa, R. Bundschuh","doi":"10.1055/a-1819-9945","DOIUrl":"https://doi.org/10.1055/a-1819-9945","url":null,"abstract":"Greek Mythology and Poetics is the second book in the Myth and Poetics series. My goal, as series editor, is to encourage work that will help integrate literary criticism with the approaches of anthropology and that will pay special attention to problems concerning the nexus of ritual and myth. For such an undertaking, we may look to the comparative testimony of relatively complex societies, such as the Ndembu of Zambia, and also of the very smallest, such as the Yukuna of the Colombian Amazon. 1 Just as important, we must pursue the varied testimonies of the most stratified societies, including those which go under the general heading \"Western civilization.\" It is precisely here that the meaning of myth is the most misleading-and challenging. In a small-scale society myth tends to be viewed as the encoding of that society's concept of truth; at the same time, from the viewpoint of Western civilization, myth has become the opposite of fact, the antithesis of truth. 2 Since the ancient Greek concept of politeiii serves as the foundation for the very word \"civilization\" and for our concept of Western civilization, more than one of the books in this series will deal primarily with ancient Greece and the ancient Greek city-state, or polis. The testimony of the Greeks is particularly instructive with regard to our central concern, the relationship between ritual and myth. The very word \"myth,\"","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79217391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01Epub Date: 2022-06-03DOI: 10.1055/a-1650-9762
Friederike Eilsberger, Michael C Kreissl, Markus Luster, Andreas Pfestroff
Theranostics via the sodium iodide symporter (NIS) offer a unique option in differentiated thyroid carcinoma. The diagnostic and therapeutic nuclides have similar uptake and kinetics, making the NIS the most important theranostic target in this disease. Radioiodine refractory thyroid carcinomas (RRTC) are characterised by reduced/absent NIS expression, thus eliminating this structure as a theranostic target. Also due to limited therapeutic options, there are approaches to generate new theranostic targets in RRTC, via the expression of somatostatin receptors (SSTR) or the prostate-specific membrane antigen (PSMA), but the current evidence does not yet allow a final evaluation of the prospects of success.
{"title":"[Therapy concepts for thyroid carcinoma].","authors":"Friederike Eilsberger, Michael C Kreissl, Markus Luster, Andreas Pfestroff","doi":"10.1055/a-1650-9762","DOIUrl":"https://doi.org/10.1055/a-1650-9762","url":null,"abstract":"<p><p>Theranostics via the sodium iodide symporter (NIS) offer a unique option in differentiated thyroid carcinoma. The diagnostic and therapeutic nuclides have similar uptake and kinetics, making the NIS the most important theranostic target in this disease. Radioiodine refractory thyroid carcinomas (RRTC) are characterised by reduced/absent NIS expression, thus eliminating this structure as a theranostic target. Also due to limited therapeutic options, there are approaches to generate new theranostic targets in RRTC, via the expression of somatostatin receptors (SSTR) or the prostate-specific membrane antigen (PSMA), but the current evidence does not yet allow a final evaluation of the prospects of success.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39514179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01Epub Date: 2022-10-08DOI: 10.1055/a-1650-9995
Matthias Miederer
Theranostic applications with radio-isotopes currently are rapidly progressing and expand nuclear medicine application in clinical routine. Alpha emitting isotopes, in particular, have long been hypothesized to achieve relevant advances for the treatment of malignancies. Here, an overview of their properties and the knowledge of radiobiology is reviewed in view of clinical translation. Clinical evidence of radiopharmaceuticals based on alpha emitters is summarized with a focus on recent developments for treatment of metastasized castration resistant prostate cancer.
{"title":"Alpha emitting nuclides in nuclear medicine theranostics.","authors":"Matthias Miederer","doi":"10.1055/a-1650-9995","DOIUrl":"https://doi.org/10.1055/a-1650-9995","url":null,"abstract":"<p><p>Theranostic applications with radio-isotopes currently are rapidly progressing and expand nuclear medicine application in clinical routine. Alpha emitting isotopes, in particular, have long been hypothesized to achieve relevant advances for the treatment of malignancies. Here, an overview of their properties and the knowledge of radiobiology is reviewed in view of clinical translation. Clinical evidence of radiopharmaceuticals based on alpha emitters is summarized with a focus on recent developments for treatment of metastasized castration resistant prostate cancer.</p>","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39498370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Kurth, Madlin Potratz, M. Heuschkel, B. Krause, S. Schwarzenböck
Addressing molecular targets, that are overexpressed by various tumor entities, using radiolabeled molecules for a combined diagnostic and therapeutic (theranostic) approach is of increasing interest in oncology. The gastrin-releasing peptide receptor (GRPr), which is part of the bombesin family, has shown to be overexpressed in a variety of tumors, therefore, serving as a promising target for those theranostic applications. A large amount of differently radiolabeled bombesin derivatives addressing the GRPr have been evaluated in the preclinical as well as clinical setting showing fast blood clearance and urinary excretion with selective GRPr-binding. Most of the available studies on GRPr-targeted imaging and therapy have evaluated the theranostic approach in prostate and breast cancer applying bombesin derivatives tagged with the predominantly used theranostic pair of 68Ga/177Lu which is the focus of this review.
{"title":"GRPr Theranostics: Current Status of Imaging and Therapy using GRPr Targeting Radiopharmaceuticals.","authors":"J. Kurth, Madlin Potratz, M. Heuschkel, B. Krause, S. Schwarzenböck","doi":"10.1055/a-1759-4189","DOIUrl":"https://doi.org/10.1055/a-1759-4189","url":null,"abstract":"Addressing molecular targets, that are overexpressed by various tumor entities, using radiolabeled molecules for a combined diagnostic and therapeutic (theranostic) approach is of increasing interest in oncology. The gastrin-releasing peptide receptor (GRPr), which is part of the bombesin family, has shown to be overexpressed in a variety of tumors, therefore, serving as a promising target for those theranostic applications. A large amount of differently radiolabeled bombesin derivatives addressing the GRPr have been evaluated in the preclinical as well as clinical setting showing fast blood clearance and urinary excretion with selective GRPr-binding. Most of the available studies on GRPr-targeted imaging and therapy have evaluated the theranostic approach in prostate and breast cancer applying bombesin derivatives tagged with the predominantly used theranostic pair of 68Ga/177Lu which is the focus of this review.","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74958396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthias Schmidt, Peter Bartenstein, Jan Bucerius, Markus Dietlein, Alexander Drzezga, Ken Herrmann, Constantin Lapa, Kerstin Lorenz, Thomas J Musholt, James Nagarajah, Christoph Reiners, Carsten O Sahlmann, Michael C Kreissl
{"title":"Correction: Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy - A German position paper from Surgery and Nuclear Medicine.","authors":"Matthias Schmidt, Peter Bartenstein, Jan Bucerius, Markus Dietlein, Alexander Drzezga, Ken Herrmann, Constantin Lapa, Kerstin Lorenz, Thomas J Musholt, James Nagarajah, Christoph Reiners, Carsten O Sahlmann, Michael C Kreissl","doi":"10.1055/a-1824-1280","DOIUrl":"10.1055/a-1824-1280","url":null,"abstract":"","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82735575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE Revisions to German radiation protection laws have resulted in updated limit values, which could affect the unrestricted release of waste produced by nuclear medicine therapy. In addition, signs of long-lived concomitant nuclides in 153Sm and 223Ra radiopharmaceuticals have been seen in the past. Therefore, the goal of this article was to analyze the radionuclidic purity of selected radiopharmaceuticals. METHOD 48 samples from 12 different radiopharmaceuticals were examined. A high purity germanium semiconductor detector (HPGe detector) was used for the qualitative and quantitative evaluation of concomitant nuclides. RESULTS Various europium isotopes were identified in 90Y-citrate, 153Sm-Quadramet, 166Ho-QuiremSpheres, and 169Er-erbium citrate, with the greatest amount being found in 153Sm (7.0 ppm (152Eu), 8.4 ppm (154Eu), and 2.1 ppm (155Eu)). 169Yb was the most significant impurity in 169Er (513 ppm). In the case of 177Lu radiopharmaceuticals, there was a significant difference in the 177mLu content (0.8 ppm vs. 0.0024 ppm) between two different manufacturers. No concomitant nuclides could be found within the detection limits in the case of 90Y spheres, 223Ra, and 225Ac. CONCLUSION The limit values for unrestricted release are exceeded manyfold in the case of the identified concomitant nuclides. As a result, alternative release procedures (extension of the decay time, specific release, release in the individual case) or transfer to collection facilities must be considered. Technical methods for reducing or preventing impurities could also be a possible solution. Consequences for patient radiation exposure were able to be ruled out.
{"title":"[Evaluation of radionuclide impurities in several radiopharmaceuticals].","authors":"R. Freudenberg, Lorenz Hesse, J. Kotzerke","doi":"10.1055/a-1759-1815","DOIUrl":"https://doi.org/10.1055/a-1759-1815","url":null,"abstract":"PURPOSE\u0000Revisions to German radiation protection laws have resulted in updated limit values, which could affect the unrestricted release of waste produced by nuclear medicine therapy. In addition, signs of long-lived concomitant nuclides in 153Sm and 223Ra radiopharmaceuticals have been seen in the past. Therefore, the goal of this article was to analyze the radionuclidic purity of selected radiopharmaceuticals.\u0000\u0000\u0000METHOD\u000048 samples from 12 different radiopharmaceuticals were examined. A high purity germanium semiconductor detector (HPGe detector) was used for the qualitative and quantitative evaluation of concomitant nuclides.\u0000\u0000\u0000RESULTS\u0000Various europium isotopes were identified in 90Y-citrate, 153Sm-Quadramet, 166Ho-QuiremSpheres, and 169Er-erbium citrate, with the greatest amount being found in 153Sm (7.0 ppm (152Eu), 8.4 ppm (154Eu), and 2.1 ppm (155Eu)). 169Yb was the most significant impurity in 169Er (513 ppm). In the case of 177Lu radiopharmaceuticals, there was a significant difference in the 177mLu content (0.8 ppm vs. 0.0024 ppm) between two different manufacturers. No concomitant nuclides could be found within the detection limits in the case of 90Y spheres, 223Ra, and 225Ac.\u0000\u0000\u0000CONCLUSION\u0000The limit values for unrestricted release are exceeded manyfold in the case of the identified concomitant nuclides. As a result, alternative release procedures (extension of the decay time, specific release, release in the individual case) or transfer to collection facilities must be considered. Technical methods for reducing or preventing impurities could also be a possible solution. Consequences for patient radiation exposure were able to be ruled out.","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73773923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter J Müller, M. Dietlein, C. Kobe, A. Heidenreich, A. Drzezga
AIM The aim of our study was to address the prevalence of oligometastatic recurrent prostate cancer (PCa) on PSMA-PET and the associated practice of metastasis-directed therapy (MDT). Next, we aimed to determine a PSA threshold below which most patients had local and/or oligometastatic recurrence on PSMA-PET. METHODS One hundred and ten consecutive patients with biochemical recurrence (BCR) after radical prostatectomy (RP) ± radiation were referred for 68Ga-PSMA-11 or 18F-DCFPyL PET/CT. We correlated the location and number of PSMA-positive lesions against the treatment choice after imaging. Detection rates were stratified by PSA levels at the time of PET/CT. The study design was monocentric retrospective. RESULTS Thirty-four patients (30.9%) had a PSMA-negative scan, while 17 (15.5%) had local recurrence and 59 (53.6%) had metastatic recurrence on PSMA-PET. ROC analysis revealed a cut-off of ≤3 metastatic lesions on PSMA-PET for the steering of treatment decisions towards MDT rather than solely systemic therapy (AUC: 0.88). Defined as 3 or fewer metastatic lesions, oligometastatic recurrent PCa was found in up to 30% (33/110) of all patients. At PSA levels below 3.5 ng/ml, the rate of PSMA-positive disease that was locally confined or oligometastatic was 76% (45/59), dropping significantly to 29.4% (5/17) above this threshold (p<0.001) as polymetastatic findings became more frequent. CONCLUSION The detection of ≤3 oligometastases on PSMA-PET encouraged the consecutive pursuit of MDT instead of systemic therapy alone. PSMA-PET predominantly captured patients at recurrence stages amenable to localized treatment when initiated at PSA levels below 3.5 ng/ml.
{"title":"Oligometastatic disease in biochemical recurrence of prostate cancer: Prevalence on PSMA PET/CT and consecutive metastasis-directed therapy - Experience at a tertiary referral center.","authors":"Peter J Müller, M. Dietlein, C. Kobe, A. Heidenreich, A. Drzezga","doi":"10.1055/a-1697-8111","DOIUrl":"https://doi.org/10.1055/a-1697-8111","url":null,"abstract":"AIM\u0000The aim of our study was to address the prevalence of oligometastatic recurrent prostate cancer (PCa) on PSMA-PET and the associated practice of metastasis-directed therapy (MDT). Next, we aimed to determine a PSA threshold below which most patients had local and/or oligometastatic recurrence on PSMA-PET.\u0000\u0000\u0000METHODS\u0000One hundred and ten consecutive patients with biochemical recurrence (BCR) after radical prostatectomy (RP) ± radiation were referred for 68Ga-PSMA-11 or 18F-DCFPyL PET/CT. We correlated the location and number of PSMA-positive lesions against the treatment choice after imaging. Detection rates were stratified by PSA levels at the time of PET/CT. The study design was monocentric retrospective.\u0000\u0000\u0000RESULTS\u0000Thirty-four patients (30.9%) had a PSMA-negative scan, while 17 (15.5%) had local recurrence and 59 (53.6%) had metastatic recurrence on PSMA-PET. ROC analysis revealed a cut-off of ≤3 metastatic lesions on PSMA-PET for the steering of treatment decisions towards MDT rather than solely systemic therapy (AUC: 0.88). Defined as 3 or fewer metastatic lesions, oligometastatic recurrent PCa was found in up to 30% (33/110) of all patients. At PSA levels below 3.5 ng/ml, the rate of PSMA-positive disease that was locally confined or oligometastatic was 76% (45/59), dropping significantly to 29.4% (5/17) above this threshold (p<0.001) as polymetastatic findings became more frequent.\u0000\u0000\u0000CONCLUSION\u0000The detection of ≤3 oligometastases on PSMA-PET encouraged the consecutive pursuit of MDT instead of systemic therapy alone. PSMA-PET predominantly captured patients at recurrence stages amenable to localized treatment when initiated at PSA levels below 3.5 ng/ml.","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75606626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rinscheid, T. Janzen, B. Alikhani, A. Beer, A. Braune, Nina Eberhardt, Diana Fechner, S. Förster, M. Freesmeyer, C. Furth, M. Grunert, D. Hellwig, P. F. Costa, C. Kühnel, C. Lange, R. Linke, N. Razlaw, Tobias Sack, D. Schmidt, Christina Schütze, Alexander Starke, Liane Tondera, H. Wengenmair, K. Zöphel, W. Burchert, C. Lapa
AIM Recently, dose reference levels (DRLs) have been defined in Germany for auxiliary low-dose CT scans in hybrid SPECT/CT and PET/CT examinations, based on data from 2016/17. Here, another survey from 2020 was evaluated and compared with the new DRLs as well as with similar surveys from foreign countries. METHODS The survey, which had already been conducted in the Nordic countries, queried for various examinations including the following values: patient weight and height, volume CT dose index (CTDIvol), dose length product (DLP). For each examination, statistical parameters such as the third quartile (Q3) were determined from all submitted CTDIvol and DLP values. Additionally, for examinations comprising datasets from at least 10 systems, the third quartile (Q3-Med) of the respective median values of each system was calculated. Q3 and Q3-Med were compared with the newly published DRLs from Germany and values from similar studies from other countries. RESULTS Data from 15 SPECT/CT and 13 PET/CT systems from 15 nuclear medicine departments were collected. For the following examinations datasets from more than 10 systems were submitted: SPECT lung VQ, SPECT bone, SPECT&PET cardiac, PET brain, PET oncology. Especially for examinations of the thorax and heart, the new DRLs are very strict compared to this study. The CTDIvol values for examinations of the head were lower in this study than the DRLs prescribe now. CONCLUSIONS For certain examination types, there is a need for dose optimization at some clinics and devices in order to take into account the new DRLs in Germany in the future.
{"title":"Radiation doses from low-dose CT scans in SPECT/CT and PET/CT examinations: A survey in Germany.","authors":"A. Rinscheid, T. Janzen, B. Alikhani, A. Beer, A. Braune, Nina Eberhardt, Diana Fechner, S. Förster, M. Freesmeyer, C. Furth, M. Grunert, D. Hellwig, P. F. Costa, C. Kühnel, C. Lange, R. Linke, N. Razlaw, Tobias Sack, D. Schmidt, Christina Schütze, Alexander Starke, Liane Tondera, H. Wengenmair, K. Zöphel, W. Burchert, C. Lapa","doi":"10.1055/a-1759-3900","DOIUrl":"https://doi.org/10.1055/a-1759-3900","url":null,"abstract":"AIM\u0000Recently, dose reference levels (DRLs) have been defined in Germany for auxiliary low-dose CT scans in hybrid SPECT/CT and PET/CT examinations, based on data from 2016/17. Here, another survey from 2020 was evaluated and compared with the new DRLs as well as with similar surveys from foreign countries.\u0000\u0000\u0000METHODS\u0000The survey, which had already been conducted in the Nordic countries, queried for various examinations including the following values: patient weight and height, volume CT dose index (CTDIvol), dose length product (DLP). For each examination, statistical parameters such as the third quartile (Q3) were determined from all submitted CTDIvol and DLP values. Additionally, for examinations comprising datasets from at least 10 systems, the third quartile (Q3-Med) of the respective median values of each system was calculated. Q3 and Q3-Med were compared with the newly published DRLs from Germany and values from similar studies from other countries.\u0000\u0000\u0000RESULTS\u0000Data from 15 SPECT/CT and 13 PET/CT systems from 15 nuclear medicine departments were collected. For the following examinations datasets from more than 10 systems were submitted: SPECT lung VQ, SPECT bone, SPECT&PET cardiac, PET brain, PET oncology. Especially for examinations of the thorax and heart, the new DRLs are very strict compared to this study. The CTDIvol values for examinations of the head were lower in this study than the DRLs prescribe now.\u0000\u0000\u0000CONCLUSIONS\u0000For certain examination types, there is a need for dose optimization at some clinics and devices in order to take into account the new DRLs in Germany in the future.","PeriodicalId":19238,"journal":{"name":"Nuklearmedizin-nuclear Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88000316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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