Pub Date : 2024-09-23DOI: 10.23736/S1824-4785.24.03587-8
Gloria Garelli, Guido Rovera, Mario Levis, Adriana Lesca, Alessia Pellerino, Francesco Bruno, Alessandra Agosti, Maria L Mangia, Martina Cioffi, Alessandro Coccarelli, Giovanni Morana, Umberto Ricardi, Roberta Rudà, Silvia Morbelli, Michela Zotta
Background: Amino-acid (AA) PET has recently been endorsed by the ESTRO-EANO guidelines for RT-planning in glioblastomas, with recommended lesion-to-brain-ratio thresholds (1.6-1.8) derived from a biopsy-controlled FET-PET study. We aimed to compare target definition at [18F]DOPA-PET between the ESTRO-EANO thresholds and other biological-tumor-volume (BTV) thresholds (derived from the striatum) typically used in [18F]DOPA-PET.
Methods: A retrospective analysis was conducted on glioma patients scanned with [18F]DOPA-PET/CT at our center between April 2021 and January 2024. 3D BTV was semi-automatically computed using a dedicated workstation (Philips HealthCare) with four thresholds: 1.6xSUVmean of background, 1.8xSUVmean of background, SUVmean and SUVmax of the contralateral striatum. The delineation accuracy of different thresholds was visually evaluated and a t-test was used to compare the different VOIs volumes (0.05 significance-level).
Results: 50 patients were included (36 previously received surgery). Volume definition based on the striatum SUVmax was significantly smaller compared to other thresholds (2.1 cm3), resulting in inaccurate VOIs at visual inspection in 21/50 patients. No significant differences were highlighted in BTV defined based on 1.6 or 1.8xSUVmean of background (15.7 vs. 12.7 cm3; VOIs accurate in 49/50 and 46/50 patients, respectively). BTV based on striatum SUVmean was significantly smaller compared to the 1.6xSUVmean threshold only in surgically-treated patients (p=0.04), while no significant differences were highlighted compared to the 1.8xSUVmean threshold regardless of the patients' group.
Conclusions: The ESTRO-EANO FET-PET thresholds proved to be interchangeable in patients scanned with [18F]DOPA-PET, while the use of a threshold based on the contralateral-striatum SUVmean provided partially overlapping results prompting further investigation.
{"title":"[18F]DOPA PET for lesion definition and contouring using different thresholds in patients with gliomas.","authors":"Gloria Garelli, Guido Rovera, Mario Levis, Adriana Lesca, Alessia Pellerino, Francesco Bruno, Alessandra Agosti, Maria L Mangia, Martina Cioffi, Alessandro Coccarelli, Giovanni Morana, Umberto Ricardi, Roberta Rudà, Silvia Morbelli, Michela Zotta","doi":"10.23736/S1824-4785.24.03587-8","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03587-8","url":null,"abstract":"<p><strong>Background: </strong>Amino-acid (AA) PET has recently been endorsed by the ESTRO-EANO guidelines for RT-planning in glioblastomas, with recommended lesion-to-brain-ratio thresholds (1.6-1.8) derived from a biopsy-controlled FET-PET study. We aimed to compare target definition at [<sup>18</sup>F]DOPA-PET between the ESTRO-EANO thresholds and other biological-tumor-volume (BTV) thresholds (derived from the striatum) typically used in [<sup>18</sup>F]DOPA-PET.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on glioma patients scanned with [<sup>18</sup>F]DOPA-PET/CT at our center between April 2021 and January 2024. 3D BTV was semi-automatically computed using a dedicated workstation (Philips HealthCare) with four thresholds: 1.6xSUV<inf>mean</inf> of background, 1.8xSUV<inf>mean</inf> of background, SUV<inf>mean</inf> and SUV<inf>max</inf> of the contralateral striatum. The delineation accuracy of different thresholds was visually evaluated and a t-test was used to compare the different VOIs volumes (0.05 significance-level).</p><p><strong>Results: </strong>50 patients were included (36 previously received surgery). Volume definition based on the striatum SUV<inf>max</inf> was significantly smaller compared to other thresholds (2.1 cm<sup>3</sup>), resulting in inaccurate VOIs at visual inspection in 21/50 patients. No significant differences were highlighted in BTV defined based on 1.6 or 1.8xSUV<inf>mean</inf> of background (15.7 vs. 12.7 cm<sup>3</sup>; VOIs accurate in 49/50 and 46/50 patients, respectively). BTV based on striatum SUV<inf>mean</inf> was significantly smaller compared to the 1.6xSUV<inf>mean</inf> threshold only in surgically-treated patients (p=0.04), while no significant differences were highlighted compared to the 1.8xSUV<inf>mean</inf> threshold regardless of the patients' group.</p><p><strong>Conclusions: </strong>The ESTRO-EANO FET-PET thresholds proved to be interchangeable in patients scanned with [<sup>18</sup>F]DOPA-PET, while the use of a threshold based on the contralateral-striatum SUV<inf>mean</inf> provided partially overlapping results prompting further investigation.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299389","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 : 2024-09-23DOI: 10.23736/S1824-4785.24.03585-4
Stefano Raffa, Luca Sofia, Nicola Girtler, Matteo Pardini, Dario Arnaldi, Beatrice Orso, Maria I Donegani, Francesca D'Amico, Francesco Lanfranchi, Guido Rovera, Federico Massa, Pietro Mattioli, Gianmario Sambuceti, Matteo Bauckneht, Silvia Morbelli
Background: Cognitive reserve (CR) is an expression of brain resilience in response to damage. Education, occupational experience and leisure activities are thought to increase CR and have beneficial effects on global cognition and cognitive decline in Parkinson's disease (PD). We aimed to disclose brain metabolic and dopaminergic correlates of CR in de-novo PD patients.
Methods: Sixty-two drug-naïve de-novo PD patients underwent [18F]FDG-PET and DAT-SPECT. CR was quantified through the Cognitive-Reserve-Index questionnaire including total-CR and 3 subscores (educational-CR, occupational-CR, leisure-CR). Specific binding ratios (SBRs) and Z-scores in basal ganglia were obtained with 'BasGan-V2'. Z-scores were used as dependent variables in general linear models to assess the interaction between dopaminergic function and CR. Voxel-based correlation between brain metabolism and CR-scores and between SBR and [18F]FDG-PET was evaluated using SPM12 (P<0.05 FWE-corrected at peak and cluster level considered significant).
Results: Dopaminergic deficit in the most affected hemisphere (MAH) putamen was significantly less marked in higher CR patients (Z-score -1.7±0.1 highly-educated versus -2.1±0.1 poorly-educated, P<0.02). Total and leisure-related-CR resulted correlated directly with z-scores of the MAH putamen (P<0.018 and P<0.003) and inversely with brain metabolism in both cerebellar hemispheres (P<0.001). MAH-putamen SBR correlated directly with metabolism in occipital and parietal cortex (P<0.003) and inversely in cerebellar hemispheres (P<0.02).
Conclusions: CR proxies demonstrated to correlate directly with dopaminergic function and inversely with metabolism in cerebellar hemispheres in de-novo PD patients. The present multi-modal approach including both metabolic and dopaminergic correlates of CR allowed to identify possible compensation mechanisms, highlighting a potential role of the cerebellum that deserves further investigation.
{"title":"Metabolic and dopaminergic correlates of intellectual enrichment in de-novo Parkinson's disease patients.","authors":"Stefano Raffa, Luca Sofia, Nicola Girtler, Matteo Pardini, Dario Arnaldi, Beatrice Orso, Maria I Donegani, Francesca D'Amico, Francesco Lanfranchi, Guido Rovera, Federico Massa, Pietro Mattioli, Gianmario Sambuceti, Matteo Bauckneht, Silvia Morbelli","doi":"10.23736/S1824-4785.24.03585-4","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03585-4","url":null,"abstract":"<p><strong>Background: </strong>Cognitive reserve (CR) is an expression of brain resilience in response to damage. Education, occupational experience and leisure activities are thought to increase CR and have beneficial effects on global cognition and cognitive decline in Parkinson's disease (PD). We aimed to disclose brain metabolic and dopaminergic correlates of CR in de-novo PD patients.</p><p><strong>Methods: </strong>Sixty-two drug-naïve de-novo PD patients underwent [<sup>18</sup>F]FDG-PET and DAT-SPECT. CR was quantified through the Cognitive-Reserve-Index questionnaire including total-CR and 3 subscores (educational-CR, occupational-CR, leisure-CR). Specific binding ratios (SBRs) and Z-scores in basal ganglia were obtained with 'BasGan-V2'. Z-scores were used as dependent variables in general linear models to assess the interaction between dopaminergic function and CR. Voxel-based correlation between brain metabolism and CR-scores and between SBR and [<sup>18</sup>F]FDG-PET was evaluated using SPM12 (P<0.05 FWE-corrected at peak and cluster level considered significant).</p><p><strong>Results: </strong>Dopaminergic deficit in the most affected hemisphere (MAH) putamen was significantly less marked in higher CR patients (Z-score -1.7±0.1 highly-educated versus -2.1±0.1 poorly-educated, P<0.02). Total and leisure-related-CR resulted correlated directly with z-scores of the MAH putamen (P<0.018 and P<0.003) and inversely with brain metabolism in both cerebellar hemispheres (P<0.001). MAH-putamen SBR correlated directly with metabolism in occipital and parietal cortex (P<0.003) and inversely in cerebellar hemispheres (P<0.02).</p><p><strong>Conclusions: </strong>CR proxies demonstrated to correlate directly with dopaminergic function and inversely with metabolism in cerebellar hemispheres in de-novo PD patients. The present multi-modal approach including both metabolic and dopaminergic correlates of CR allowed to identify possible compensation mechanisms, highlighting a potential role of the cerebellum that deserves further investigation.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299324","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 : 2024-09-18DOI: 10.23736/S1824-4785.24.03582-9
Tatiana Horowitz, Stephan Grimaldi, Henri Dufour, Thomas Graillon, Jean-Philippe Azulay, Eric Guedj
Background: The pathophysiology of normal pressure hydrocephalus (NPH) has not been fully elucidated. Treating NPH with cerebrospinal fluid shunts to improve gait disturbances may have some risks and inconsistent benefits. No clear predictive factor has been identified thus far. This preliminary study aimed to evaluate the predictive value of preoperative brain 18F-FDG positron emission tomography (PET) on overall gait response in patients with NPH.
Methods: Sixteen patients with NPH who underwent 18F-FDG PET before shunt surgery between 2012 and 2022 were included retrospectively and separated into two groups based on their gait response one year after surgery: responders (R) or nonresponders (NR). Brain glucose metabolism was assessed using visual and semiquantitative analyses using SPM8 software (Welcome Department of Cognitive Neurology, University College, London, UK). Five regions of interest were selected: global cortex, cerebellum, thalamus, striatum, and midbrain.
Results: Visual interpretation showed more frequent hypometabolism of the striatum, thalamus and global cortex in NR. None of the patients showing hypometabolism of these regions were R. Based on these results, the visual interpretation allowed us to identify 3/8 NR and 8/8 R. Semiquantitative analysis confirmed significantly lower thalamic metabolism in the NR group (P=0.037) and a trend towards lower metabolism of the striatum (P=0.075) with an area under the curve of 0.77 for thalamic metabolism to discriminate between R and NR.
Conclusions: This preliminary study using brain 18F-FDG PET suggests that reduced brain metabolism in the thalamus and striatum along with cortical hypometabolism may be associated with poorer gait response to CSF shunting in normal pressure hydrocephalus (NPH). Although these findings suggest that preoperative brain 18F-FDG PET could potentially aid in selecting appropriate candidates for shunt surgery, further research with larger sample sizes is needed to confirm these results.
背景:正常压力脑积水(NPH)的病理生理学尚未完全阐明。用脑脊液分流术治疗正常压力脑积水以改善步态障碍可能有一定的风险,但获益却不一致。迄今为止,尚未发现明确的预测因素。本初步研究旨在评估术前脑部 18F-FDG 正电子发射断层扫描(PET)对 NPH 患者总体步态反应的预测价值:回顾性纳入2012年至2022年期间在分流手术前接受18F-FDG正电子发射断层扫描的16例NPH患者,并根据他们术后一年的步态反应分为两组:反应者(R)或无反应者(NR)。使用 SPM8 软件(欢迎使用英国伦敦大学学院认知神经学系)进行视觉和半定量分析,评估脑葡萄糖代谢。选择了五个感兴趣的区域:大脑皮层、小脑、丘脑、纹状体和中脑:结果:视觉解读显示,在 NR 中,纹状体、丘脑和全脑皮层的代谢减低更为常见。半定量分析证实,NR 组丘脑代谢显著降低(P=0.037),纹状体代谢呈降低趋势(P=0.075),丘脑代谢的曲线下面积为 0.77,可用于区分 R 和 NR:这项使用脑18F-FDG PET的初步研究表明,丘脑和纹状体的脑代谢降低以及皮质代谢不足可能与正常压力脑积水(NPH)患者对CSF分流的步态反应较差有关。尽管这些研究结果表明,术前脑部 18F-FDG PET 有可能有助于选择合适的分流手术候选者,但还需要更大样本量的进一步研究来证实这些结果。
{"title":"18F-FDG brain PET: a metabolic predictive factor for gait improvement after cerebrospinal fluid shunting in normal pressure hydrocephalus?","authors":"Tatiana Horowitz, Stephan Grimaldi, Henri Dufour, Thomas Graillon, Jean-Philippe Azulay, Eric Guedj","doi":"10.23736/S1824-4785.24.03582-9","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03582-9","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of normal pressure hydrocephalus (NPH) has not been fully elucidated. Treating NPH with cerebrospinal fluid shunts to improve gait disturbances may have some risks and inconsistent benefits. No clear predictive factor has been identified thus far. This preliminary study aimed to evaluate the predictive value of preoperative brain <sup>18</sup>F-FDG positron emission tomography (PET) on overall gait response in patients with NPH.</p><p><strong>Methods: </strong>Sixteen patients with NPH who underwent <sup>18</sup>F-FDG PET before shunt surgery between 2012 and 2022 were included retrospectively and separated into two groups based on their gait response one year after surgery: responders (R) or nonresponders (NR). Brain glucose metabolism was assessed using visual and semiquantitative analyses using SPM8 software (Welcome Department of Cognitive Neurology, University College, London, UK). Five regions of interest were selected: global cortex, cerebellum, thalamus, striatum, and midbrain.</p><p><strong>Results: </strong>Visual interpretation showed more frequent hypometabolism of the striatum, thalamus and global cortex in NR. None of the patients showing hypometabolism of these regions were R. Based on these results, the visual interpretation allowed us to identify 3/8 NR and 8/8 R. Semiquantitative analysis confirmed significantly lower thalamic metabolism in the NR group (P=0.037) and a trend towards lower metabolism of the striatum (P=0.075) with an area under the curve of 0.77 for thalamic metabolism to discriminate between R and NR.</p><p><strong>Conclusions: </strong>This preliminary study using brain <sup>18</sup>F-FDG PET suggests that reduced brain metabolism in the thalamus and striatum along with cortical hypometabolism may be associated with poorer gait response to CSF shunting in normal pressure hydrocephalus (NPH). Although these findings suggest that preoperative brain 18F-FDG PET could potentially aid in selecting appropriate candidates for shunt surgery, further research with larger sample sizes is needed to confirm these results.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299322","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 : 2024-09-12DOI: 10.23736/S1824-4785.24.03583-0
Giacomo Rebella, Denise Cerne, Luana Benedetti, Silvia Morbelli, Martina Resaz, Antonio Uccelli, Lucio Castellan, Flavio Villani, Enrico Peira, Federico Massa, Luca Roccatagliata
Background: Arterial spin labeling (ASL) MRI has been anecdotally used to assess brain perfusion in autoimmune encephalitis (AE) and its relationship with [18F]FDG-PET dysmetabolism has been scarcely investigated.Considering the physiological coupling of metabolism and perfusion, we aimed to evaluate the degree of correspondence between ASL-MRI and [18F]FDG-PET in AE.
Methods: A retrospective cohort of five patients underwent ASL-MRI and [18F]FDG-PET during the acute stage and at follow-up. We assessed the presence of regions with hypermetabolism on [18F]FDG-PET and hyperperfusion on ASL-MRI and evaluated concordance and spatial overlap of these metrics. Clinical assessment scale in AE and modified Rankin Scale were obtained at baseline and follow-up.
Results: In two patients [18F]FDG-PET and ASL-MRI were unremarkable; in three patients there were anatomically overlapping areas of hypermetabolism and hyperperfusion (average DICE similarity coefficient 0.358). Following immunotherapy, metabolic and perfusion changes consistently demonstrated a progressive normalization, aligning with clinical improvement.
Conclusions: We identified suboptimal anatomical correspondence of abnormalities assessed with [18F]FDG-PET and ASL-MRI. Hyperperfusion and hypermetabolism might reflect differently AE-related pathophysiological correlates, but they both demonstrate ability to monitor disease activity. ASL-MRI is a promising marker of disease activity in AE and a favorable alternative to [18F]FDG-PET due to its cost-effectiveness, safety, and wide availability.
{"title":"FDG-PET and ASL MRI identify largely overlapping hypermetabolic and hyperperfusion changes in limbic autoimmune encephalitis.","authors":"Giacomo Rebella, Denise Cerne, Luana Benedetti, Silvia Morbelli, Martina Resaz, Antonio Uccelli, Lucio Castellan, Flavio Villani, Enrico Peira, Federico Massa, Luca Roccatagliata","doi":"10.23736/S1824-4785.24.03583-0","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03583-0","url":null,"abstract":"<p><strong>Background: </strong>Arterial spin labeling (ASL) MRI has been anecdotally used to assess brain perfusion in autoimmune encephalitis (AE) and its relationship with [<sup>18</sup>F]FDG-PET dysmetabolism has been scarcely investigated.Considering the physiological coupling of metabolism and perfusion, we aimed to evaluate the degree of correspondence between ASL-MRI and [<sup>18</sup>F]FDG-PET in AE.</p><p><strong>Methods: </strong>A retrospective cohort of five patients underwent ASL-MRI and [<sup>18</sup>F]FDG-PET during the acute stage and at follow-up. We assessed the presence of regions with hypermetabolism on [<sup>18</sup>F]FDG-PET and hyperperfusion on ASL-MRI and evaluated concordance and spatial overlap of these metrics. Clinical assessment scale in AE and modified Rankin Scale were obtained at baseline and follow-up.</p><p><strong>Results: </strong>In two patients [<sup>18</sup>F]FDG-PET and ASL-MRI were unremarkable; in three patients there were anatomically overlapping areas of hypermetabolism and hyperperfusion (average DICE similarity coefficient 0.358). Following immunotherapy, metabolic and perfusion changes consistently demonstrated a progressive normalization, aligning with clinical improvement.</p><p><strong>Conclusions: </strong>We identified suboptimal anatomical correspondence of abnormalities assessed with [<sup>18</sup>F]FDG-PET and ASL-MRI. Hyperperfusion and hypermetabolism might reflect differently AE-related pathophysiological correlates, but they both demonstrate ability to monitor disease activity. ASL-MRI is a promising marker of disease activity in AE and a favorable alternative to [<sup>18</sup>F]FDG-PET due to its cost-effectiveness, safety, and wide availability.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299323","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 : 2024-08-01DOI: 10.23736/S1824-4785.24.03572-6
Ahmad Arar, Alex Heglin, Shriya Veluri, Mohammed W Alnablsi, Jamaal L Benjamin, Moaz Choudhary, Anil Pillai
Transarterial radioembolization (TARE), also called Selective Internal Radiation Therapy (SIRT), has emerged as an effective locoregional therapy for primary and secondary hepatic tumors, utilizing yttrium-90 (Y90) microspheres and other agents such as holmium-166 and rhenium-188. TARE has various applications in the management of HCC across different BCLC stages. Radiation segmentectomy, which involves administering high doses of Y90 (>190 Gy), can be both curative and ablative, achieving complete necrosis of the tumor. In contrast, radiation lobectomy involves administering a lower dose of Y90 (80-120 Gy) as a neoadjuvant treatment modality to improve local control and induce future liver remnant (FLR) hypertrophy in patients who are planned to undergo surgery but have insufficient FLR. Modified radiation lobectomy combines both techniques and offers several advantages over portal vein embolization (PVE). Y90 is also used in downstaging HCC patients outside liver transplantation criteria, as well as bridging those awaiting liver transplantation (LT). Multiple studies and combined analyses were described to highlight the outcomes of TARE and compare it with other treatment modalities, including TACE and sorafenib. Additionally, the review delves into the efficacy and safety of radioembolization in managing metastatic colorectal cancer and other metastatic tumors to the liver. Recent studies have emphasized the role of personalized dosimetry for improved outcomes, and thus we described the different methods used for this purpose. Pretherapy imaging, estimating lung shunt, selection of therapeutic radionuclides, adverse effects, and cost-effectiveness were all discussed as well.
{"title":"Radioembolization of HCC and secondary hepatic tumors: a comprehensive review.","authors":"Ahmad Arar, Alex Heglin, Shriya Veluri, Mohammed W Alnablsi, Jamaal L Benjamin, Moaz Choudhary, Anil Pillai","doi":"10.23736/S1824-4785.24.03572-6","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03572-6","url":null,"abstract":"<p><p>Transarterial radioembolization (TARE), also called Selective Internal Radiation Therapy (SIRT), has emerged as an effective locoregional therapy for primary and secondary hepatic tumors, utilizing yttrium-90 (Y90) microspheres and other agents such as holmium-166 and rhenium-188. TARE has various applications in the management of HCC across different BCLC stages. Radiation segmentectomy, which involves administering high doses of Y90 (>190 Gy), can be both curative and ablative, achieving complete necrosis of the tumor. In contrast, radiation lobectomy involves administering a lower dose of Y90 (80-120 Gy) as a neoadjuvant treatment modality to improve local control and induce future liver remnant (FLR) hypertrophy in patients who are planned to undergo surgery but have insufficient FLR. Modified radiation lobectomy combines both techniques and offers several advantages over portal vein embolization (PVE). Y90 is also used in downstaging HCC patients outside liver transplantation criteria, as well as bridging those awaiting liver transplantation (LT). Multiple studies and combined analyses were described to highlight the outcomes of TARE and compare it with other treatment modalities, including TACE and sorafenib. Additionally, the review delves into the efficacy and safety of radioembolization in managing metastatic colorectal cancer and other metastatic tumors to the liver. Recent studies have emphasized the role of personalized dosimetry for improved outcomes, and thus we described the different methods used for this purpose. Pretherapy imaging, estimating lung shunt, selection of therapeutic radionuclides, adverse effects, and cost-effectiveness were all discussed as well.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861368","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 : 2024-07-19DOI: 10.23736/S1824-4785.24.03571-4
Caroline Boursier, Timothée Zaragori, Laëtitia Imbert, Antoine Verger
Introduction: Few therapeutic options are currently available for refractory meningiomas. Encouraging results have been reported for 177Lu-labeled somatostatin receptor-targeted radiopeptide therapy (SSTR-RT). The current therapeutic scheme is based on the fixed doses that are recommended for neuroendocrine tumor treatment. However, in personalized medicine, tumor dosimetry can be determined from repeat 177Lu scintigraphy. The aim of this review was to report on the methods used for calculating the tumor absorbed dose (AD) in meningioma patients treated with 177Lu-SSTR-RT and their values.
Evidence acquisition: The search was performed in Medline, Embase and the Cochrane Library until March 1st, 2024 to retrieve papers related to the topic. The following terms were used for searching: (meningioma) AND ((sstr) OR (receptors somatostatin) OR (somatostatin) OR (octreotide)) AND ((PRRT) OR (radionuclide therapy) OR (dotatate) OR (dotatoc) OR (177Lu-DOTATOC) OR (177Lu-DOTATATE) OR (radiopeptide)).
Evidence synthesis: Seven articles (including 46 patients and 108 cycles of treatment) reporting on tumor AD during 177Lu-SSTR-RT were included in the analysis. The methods of acquisition, reconstruction parameters and postimage processing to determine tumor AD were very heterogeneous among the studies. The meningioma AD associated with the agonist 177Lu-SSTR-RT reported in the majority of studies ranged from 0.1-1.5 Gy/GBq, which was lower than that reported for neuroendocrine tumors (1.3-22.9 Gy/GBq).
Conclusions: The tumor AD that was reported during treatment with 177Lu-SSTR-RT in refractory meningioma patients is generally low. Harmonization of the methodology for dosimetry calculations is needed to compare the different reported values and optimize treatment at the individual level.
导言:目前,治疗难治性脑膜瘤的方法很少。据报道,177Lu标记的体生长抑素受体靶向放射肽疗法(SSTR-RT)取得了令人鼓舞的结果。目前的治疗方案以神经内分泌肿瘤治疗推荐的固定剂量为基础。然而,在个性化医疗中,肿瘤剂量可以通过重复 177Lu 闪烁扫描来确定。本综述旨在报告用于计算脑膜瘤患者接受177Lu-SSTR-RT治疗后的肿瘤吸收剂量(AD)的方法及其数值:在 Medline、Embase 和 Cochrane 图书馆进行检索,检索时间截至 2024 年 3 月 1 日,以检索与该主题相关的论文。检索时使用了以下术语:(脑膜瘤) AND ((sstr) OR (receptors somatostatin) OR (somatostatin) OR (octreotide)) AND ((PRRT) OR (radionuclide therapy) OR (dotatate) OR (dotatoc) OR (177Lu-DOTATOC) OR (177Lu-DOTATATE) OR (radiopeptide)).Evidence synthesis.证据综述:有七篇文章(包括 46 名患者和 108 个治疗周期)报道了 177Lu-SSTR-RT 期间肿瘤 AD 的情况。这些研究在确定肿瘤AD的采集方法、重建参数和图像后期处理方面存在很大差异。大多数研究报告的脑膜瘤与激动剂177Lu-SSTR-RT相关的AD为0.1-1.5 Gy/GBq,低于神经内分泌肿瘤的AD(1.3-22.9 Gy/GBq):结论:据报道,难治性脑膜瘤患者在接受 177Lu-SSTR-RT 治疗期间的肿瘤 AD 值普遍较低。需要统一剂量测定计算方法,以比较不同的报告值,优化个体治疗。
{"title":"177Lu-labeled somatostatin receptor targeted radionuclide therapy dosimetry in meningioma: a systematic review.","authors":"Caroline Boursier, Timothée Zaragori, Laëtitia Imbert, Antoine Verger","doi":"10.23736/S1824-4785.24.03571-4","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03571-4","url":null,"abstract":"<p><strong>Introduction: </strong>Few therapeutic options are currently available for refractory meningiomas. Encouraging results have been reported for <sup>177</sup>Lu-labeled somatostatin receptor-targeted radiopeptide therapy (SSTR-RT). The current therapeutic scheme is based on the fixed doses that are recommended for neuroendocrine tumor treatment. However, in personalized medicine, tumor dosimetry can be determined from repeat <sup>177</sup>Lu scintigraphy. The aim of this review was to report on the methods used for calculating the tumor absorbed dose (AD) in meningioma patients treated with <sup>177</sup>Lu-SSTR-RT and their values.</p><p><strong>Evidence acquisition: </strong>The search was performed in Medline, Embase and the Cochrane Library until March 1<sup>st</sup>, 2024 to retrieve papers related to the topic. The following terms were used for searching: (meningioma) AND ((sstr) OR (receptors somatostatin) OR (somatostatin) OR (octreotide)) AND ((PRRT) OR (radionuclide therapy) OR (dotatate) OR (dotatoc) OR (177Lu-DOTATOC) OR (177Lu-DOTATATE) OR (radiopeptide)).</p><p><strong>Evidence synthesis: </strong>Seven articles (including 46 patients and 108 cycles of treatment) reporting on tumor AD during <sup>177</sup>Lu-SSTR-RT were included in the analysis. The methods of acquisition, reconstruction parameters and postimage processing to determine tumor AD were very heterogeneous among the studies. The meningioma AD associated with the agonist <sup>177</sup>Lu-SSTR-RT reported in the majority of studies ranged from 0.1-1.5 Gy/GBq, which was lower than that reported for neuroendocrine tumors (1.3-22.9 Gy/GBq).</p><p><strong>Conclusions: </strong>The tumor AD that was reported during treatment with <sup>177</sup>Lu-SSTR-RT in refractory meningioma patients is generally low. Harmonization of the methodology for dosimetry calculations is needed to compare the different reported values and optimize treatment at the individual level.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724876","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 : 2024-07-17DOI: 10.23736/S1824-4785.24.03570-2
Sébastien Heyer, Matthieu Doyen, Antoine Verger
Introduction: Metabolic connectivity has been studied in various neurodegenerative diseases, particularly Alzheimer's disease (AD), but there is a wealth of accumulated evidence and sometimes conflicting results, depending on the methodology applied. Therefore, the aim of this systematic review was to summarize the results obtained regarding metabolic brain connectivity using [18F]-FDG-PET in AD patients compared to cognitively normal subjects.
Evidence acquisition: A systematic and exhaustive search of data available in the literature was carried out by querying the PubMed and Web of Science databases. Studies had to meet the following criteria: 1) a metabolic connectivity study with [18F]-FDG-PET in AD patients; 2) the inclusion of a control group of healthy subjects or cognitively normal controls; and 3) use of seed-based, independent/principal component analyses or methods derived from graph theory. This systematic review followed the PRISMA method.
Evidence synthesis: A total of 49 full-text publications were included, involving 3589 AD patients, 3272 prodromal AD patients and 3898 cognitively normal subjects. These results show that AD patients have a reorganization of metabolic connectivity on a global scale, with a decrease in or even the loss of networks seen in the healthy brain and an increase in more local, less efficient connectivity. This reorganization affects not only areas commonly affected in AD but also remote regions known to be usually spared in this pathology.
Conclusions: Changes in metabolic connectivity in AD patients do not simply constitute a decrease in global connectivity but rather more complex local and global changes ultimately affecting all brain regions.
简介对各种神经退行性疾病,尤其是阿尔茨海默病(AD)的代谢连通性进行了研究,但积累了大量的证据,有时会出现相互矛盾的结果,这取决于所采用的方法。因此,本系统性综述旨在总结使用[18F]-FDG-PET对AD患者与认知能力正常的受试者进行脑代谢连通性研究的结果:通过查询 PubMed 和 Web of Science 数据库,对文献中的数据进行了系统而详尽的搜索。研究必须符合以下标准:1)使用[18F]-FDG-PET对AD患者进行代谢连通性研究;2)纳入健康受试者对照组或认知正常对照组;3)使用基于种子的独立/主要成分分析或源自图论的方法。本系统综述遵循 PRISMA 方法:共纳入 49 篇全文出版物,涉及 3589 名 AD 患者、3272 名 AD 前驱期患者和 3898 名认知正常的受试者。这些结果表明,AD 患者的代谢连通性在全球范围内发生了重组,健康大脑中的网络减少甚至消失,而更局部、更低效的连通性增加。这种重组不仅影响到常见的注意力缺失症受影响区域,而且还影响到已知在这种病症中通常不受影响的偏远区域:结论:AD 患者代谢连接性的变化并不仅仅是全球连接性的降低,而是更为复杂的局部和全球变化,最终影响到所有大脑区域。
{"title":"Metabolic brain connectivity reorganization in Alzheimer's disease patients: a systematic review.","authors":"Sébastien Heyer, Matthieu Doyen, Antoine Verger","doi":"10.23736/S1824-4785.24.03570-2","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03570-2","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic connectivity has been studied in various neurodegenerative diseases, particularly Alzheimer's disease (AD), but there is a wealth of accumulated evidence and sometimes conflicting results, depending on the methodology applied. Therefore, the aim of this systematic review was to summarize the results obtained regarding metabolic brain connectivity using [<sup>18</sup>F]-FDG-PET in AD patients compared to cognitively normal subjects.</p><p><strong>Evidence acquisition: </strong>A systematic and exhaustive search of data available in the literature was carried out by querying the PubMed and Web of Science databases. Studies had to meet the following criteria: 1) a metabolic connectivity study with [18F]-FDG-PET in AD patients; 2) the inclusion of a control group of healthy subjects or cognitively normal controls; and 3) use of seed-based, independent/principal component analyses or methods derived from graph theory. This systematic review followed the PRISMA method.</p><p><strong>Evidence synthesis: </strong>A total of 49 full-text publications were included, involving 3589 AD patients, 3272 prodromal AD patients and 3898 cognitively normal subjects. These results show that AD patients have a reorganization of metabolic connectivity on a global scale, with a decrease in or even the loss of networks seen in the healthy brain and an increase in more local, less efficient connectivity. This reorganization affects not only areas commonly affected in AD but also remote regions known to be usually spared in this pathology.</p><p><strong>Conclusions: </strong>Changes in metabolic connectivity in AD patients do not simply constitute a decrease in global connectivity but rather more complex local and global changes ultimately affecting all brain regions.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141628141","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 : 2024-07-15DOI: 10.23736/S1824-4785.24.03535-0
Hui C Wang, Zhi M Wang, Wei D Hu, Xiao Q Liang, Lan L Cui
Background: Epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) are the two most common druggable targets in non-small cell lung cancer (NSCLC). To investigate whether the EGFR mutation and ALK rearrangement could be predicted by the combination of FDG avidity, tumor markers and Ki-67 Index.
Methods: A total of 168 newly diagnosed NSCLC patients who had undergone 18F-FDG PET/CT for staging were enrolled. PET/CT parameters of primary tumors including maximum standardized uptake value (pSUVmax), metabolic tumor volume (pMTV) and total lesion glycolysis (pTLG) were measured. Five serous tumor markers for lung cancer were recorded. Ki-67 labeling index was counted by immunohistochemical staining. EGFR mutation and ALK status were detected by ARMS-PCR and RT-PCR, respectively. Univariate and multivariate analyses were applied to identify the predictors of EGFR mutation and ALK positivity.
Results: EGFR mutation rate was 38.1% (64/168), which were found more frequently in female, ≤60 years old, non-smokers and adenocarcinoma patients, and were not related to lymph node involvements, distant metastases, stage and serum tumor markers. Low pSUVmax, pMTV, pTLG and Ki-67 were significantly associated with EGFR mutation. Logistic regression demonstrated that pSUVmax <6.75 and gender (female) were the independent factors affecting EGFR mutation, and the combination of them had a certain predictive value with the area under the curve of 0.784. ALK positive rate was 6.0% (10/168), all of them were adenocarcinoma patients, which were more common in non-smokers, low serum cytokeratin-19 fragment antigen (CYFRA21-1) and low Ki-67, and were not related to FDG activity. No independent factor for ALK positivity was found on Logistic regression.
Conclusions: Low pSUVmax, rather than tumor markers or Ki-67, was correlated with EGFR mutation independently, which could be integrated with gender (female) to improve the identification for EGFR mutation in NSCLC patients.
{"title":"Correlation of FDG PET/CT, tumor markers and Ki-67 index with EGFR mutation or positive ALK expression in patients with non-small cell lung cancer.","authors":"Hui C Wang, Zhi M Wang, Wei D Hu, Xiao Q Liang, Lan L Cui","doi":"10.23736/S1824-4785.24.03535-0","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03535-0","url":null,"abstract":"<p><strong>Background: </strong>Epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) are the two most common druggable targets in non-small cell lung cancer (NSCLC). To investigate whether the EGFR mutation and ALK rearrangement could be predicted by the combination of FDG avidity, tumor markers and Ki-67 Index.</p><p><strong>Methods: </strong>A total of 168 newly diagnosed NSCLC patients who had undergone <sup>18</sup>F-FDG PET/CT for staging were enrolled. PET/CT parameters of primary tumors including maximum standardized uptake value (pSUVmax), metabolic tumor volume (pMTV) and total lesion glycolysis (pTLG) were measured. Five serous tumor markers for lung cancer were recorded. Ki-67 labeling index was counted by immunohistochemical staining. EGFR mutation and ALK status were detected by ARMS-PCR and RT-PCR, respectively. Univariate and multivariate analyses were applied to identify the predictors of EGFR mutation and ALK positivity.</p><p><strong>Results: </strong>EGFR mutation rate was 38.1% (64/168), which were found more frequently in female, ≤60 years old, non-smokers and adenocarcinoma patients, and were not related to lymph node involvements, distant metastases, stage and serum tumor markers. Low pSUVmax, pMTV, pTLG and Ki-67 were significantly associated with EGFR mutation. Logistic regression demonstrated that pSUVmax <6.75 and gender (female) were the independent factors affecting EGFR mutation, and the combination of them had a certain predictive value with the area under the curve of 0.784. ALK positive rate was 6.0% (10/168), all of them were adenocarcinoma patients, which were more common in non-smokers, low serum cytokeratin-19 fragment antigen (CYFRA21-1) and low Ki-67, and were not related to FDG activity. No independent factor for ALK positivity was found on Logistic regression.</p><p><strong>Conclusions: </strong>Low pSUVmax, rather than tumor markers or Ki-67, was correlated with EGFR mutation independently, which could be integrated with gender (female) to improve the identification for EGFR mutation in NSCLC patients.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617476","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 : 2024-07-11DOI: 10.23736/S1824-4785.24.03529-5
Jie Wang, Qing Zeng
Background: The diagnostic utility of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) compared to bone marrow biopsy (BMB) in patients with non-Hodgkin lymphoma (NHL) remained to be confirmed. This study aimed to compare BMB and PET/CT for bone marrow infiltration (BMI) in patients with NHL.
Methods: PubMed, Embase, and the Cochrane library were searched for papers published up to October 2021. The outcomes were the true positive and negative and false positive and negative rates for BMB and PET/CT. The summarized sensitivity, specificity, positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratios (DOR) were calculated.
Results: Thirteen studies with a total of 2396 patients were included. Significant differences are observed between BMB and PET/CT for sensitivity (relative ratio: 0.749; 95% CI: 0.586-0.956; P=0.020) and NLR (relative ratio: 1.839; 95% CI: 1.106-3.058; P=0.019), but not for specificity (P=0.819), PLR (P=0.802), and DOR (P=0.150). The summary area under the receiver operating characteristic curves for BMB is 0.692 (SE: 0.170) and 0.977 (SE: 0.021) for PET/CT.
Conclusions: PET/CT presents a better sensitivity and NLR for the detection of BMI in patients with NHL, whereas no differences are found regarding specificity, PLR, and DOR compared with BMB.
{"title":"Direct comparison of bone marrow biopsy and PET/CT for the detection of bone marrow infiltration in patients with non-Hodgkin lymphoma: a meta-analysis.","authors":"Jie Wang, Qing Zeng","doi":"10.23736/S1824-4785.24.03529-5","DOIUrl":"https://doi.org/10.23736/S1824-4785.24.03529-5","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic utility of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) compared to bone marrow biopsy (BMB) in patients with non-Hodgkin lymphoma (NHL) remained to be confirmed. This study aimed to compare BMB and PET/CT for bone marrow infiltration (BMI) in patients with NHL.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane library were searched for papers published up to October 2021. The outcomes were the true positive and negative and false positive and negative rates for BMB and PET/CT. The summarized sensitivity, specificity, positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratios (DOR) were calculated.</p><p><strong>Results: </strong>Thirteen studies with a total of 2396 patients were included. Significant differences are observed between BMB and PET/CT for sensitivity (relative ratio: 0.749; 95% CI: 0.586-0.956; P=0.020) and NLR (relative ratio: 1.839; 95% CI: 1.106-3.058; P=0.019), but not for specificity (P=0.819), PLR (P=0.802), and DOR (P=0.150). The summary area under the receiver operating characteristic curves for BMB is 0.692 (SE: 0.170) and 0.977 (SE: 0.021) for PET/CT.</p><p><strong>Conclusions: </strong>PET/CT presents a better sensitivity and NLR for the detection of BMI in patients with NHL, whereas no differences are found regarding specificity, PLR, and DOR compared with BMB.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581302","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 : 2024-06-01DOI: 10.23736/S1824-4785.24.03575-1
Francesco Ceci, Lighea S Airò Farulla, Elena Bonatto, Laura Evangelista, Marta Aliprandi, Luigi G Cecchi, Francesco Mattana, Alessandro Bertocchi, Fabio DE Vincenzo, Matteo Perrino, Nadia Cordua, Federica Borea, Paolo A Zucali
Prostate cancer (PCa) remains a significant global health challenge, particularly in its advanced stages. Despite progress in early detection and treatment, PCa is the second most common cancer diagnosis among men. This review aims to provide an overview of current therapeutic approaches and innovations in PCa management, focusing on the latest advancements and ongoing challenges. We conducted a narrative review of clinical trials and research studies, focusing on PARP inhibitors (PARPis), phosphoinositide 3 kinase-protein kinase B inhibitors, immunotherapy, and radioligand therapies (RLTs). Data was sourced from major clinical trial databases and peer-reviewed journals. Androgen deprivation therapy and androgen-receptor pathway inhibitors remain foundational in managing castration-sensitive and early-stage castration-resistant PCa (CRPC). PARPi's, such as olaparib and rucaparib, have emerged as vital treatments for metastatic CRPC with homologous recombination repair gene mutations, highlighting the importance of personalized medicine. Immune checkpoint inhibitors (ICIs) have shown clinical benefit limited to specific subgroups of PCa, demonstrating significant improvement in efficacy in patients with microsatellite instability/mismatch repair or cyclin-dependent kinase 12 alteration, highlighting the importance of focusing ongoing research on identifying and characterizing these subgroups to maximize the clinical benefits of ICIs. RLTs have shown effectiveness in treating mCRPC. Different alpha emitters (like [225Ac]PSMA) and beta emitters compounds (like [177Lu]PSMA) impact treatment differently due to their energy transfer characteristics. Clinical trials like VISION and TheraP have demonstrated positive outcomes with RLT, particularly [177Lu]PSMA-617, leading to FDA approval. Ongoing trials and future perspectives explore the potential of [225Ac]PSMA, aiming to improve outcomes for patients with mCRPC. The landscape of PCa treatment is evolving, with significant advancements in both established and novel therapies. The combination of hormonal therapies, chemotherapy, PARPis, immunotherapy, and RLTs, guided by genetic and molecular insights, opens new possibilities for personalized treatment.
{"title":"New target therapies in prostate cancer: from radioligand therapy, to PARP-inhibitors and immunotherapy.","authors":"Francesco Ceci, Lighea S Airò Farulla, Elena Bonatto, Laura Evangelista, Marta Aliprandi, Luigi G Cecchi, Francesco Mattana, Alessandro Bertocchi, Fabio DE Vincenzo, Matteo Perrino, Nadia Cordua, Federica Borea, Paolo A Zucali","doi":"10.23736/S1824-4785.24.03575-1","DOIUrl":"10.23736/S1824-4785.24.03575-1","url":null,"abstract":"<p><p>Prostate cancer (PCa) remains a significant global health challenge, particularly in its advanced stages. Despite progress in early detection and treatment, PCa is the second most common cancer diagnosis among men. This review aims to provide an overview of current therapeutic approaches and innovations in PCa management, focusing on the latest advancements and ongoing challenges. We conducted a narrative review of clinical trials and research studies, focusing on PARP inhibitors (PARPis), phosphoinositide 3 kinase-protein kinase B inhibitors, immunotherapy, and radioligand therapies (RLTs). Data was sourced from major clinical trial databases and peer-reviewed journals. Androgen deprivation therapy and androgen-receptor pathway inhibitors remain foundational in managing castration-sensitive and early-stage castration-resistant PCa (CRPC). PARPi's, such as olaparib and rucaparib, have emerged as vital treatments for metastatic CRPC with homologous recombination repair gene mutations, highlighting the importance of personalized medicine. Immune checkpoint inhibitors (ICIs) have shown clinical benefit limited to specific subgroups of PCa, demonstrating significant improvement in efficacy in patients with microsatellite instability/mismatch repair or cyclin-dependent kinase 12 alteration, highlighting the importance of focusing ongoing research on identifying and characterizing these subgroups to maximize the clinical benefits of ICIs. RLTs have shown effectiveness in treating mCRPC. Different alpha emitters (like [<sup>225</sup>Ac]PSMA) and beta emitters compounds (like [<sup>177</sup>Lu]PSMA) impact treatment differently due to their energy transfer characteristics. Clinical trials like VISION and TheraP have demonstrated positive outcomes with RLT, particularly [<sup>177</sup>Lu]PSMA-617, leading to FDA approval. Ongoing trials and future perspectives explore the potential of [<sup>225</sup>Ac]PSMA, aiming to improve outcomes for patients with mCRPC. The landscape of PCa treatment is evolving, with significant advancements in both established and novel therapies. The combination of hormonal therapies, chemotherapy, PARPis, immunotherapy, and RLTs, guided by genetic and molecular insights, opens new possibilities for personalized treatment.</p>","PeriodicalId":49135,"journal":{"name":"the Quarterly Journal of Nuclear Medicine and Molecular Imaging","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301912","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}