Revista espanola de medicina nuclear e imagen molecular最新文献

This article critically reviews the available evidence on the role of PSMA-PET in evaluating therapeutic response in metastatic prostate cancer (mPC), comparing it with conventional criteria -serum PSA levels, Response Evaluation Criteria in Solid Tumours (RECIST 1.1), Prostate Cancer Working Group 3 (PCWG3)- and analyzing its integration into clinical practice. It addresses the biological basis of PSMA and how different treatments -androgen deprivation therapy (ADT), androgen receptor pathway inhibitors (ARPI), taxanes, [¹⁷⁷Lu]Lu-PSMA-617, [²²³Ra], stereotactic body radiotherapy (SBRT)- modulate its expression, which influences image interpretation and phenomena such as flare. This work describes specific assessment systems for PSMA-PET, including PSMA PET Progression Criteria (PPP), Response Evaluation Criteria in PSMA (RECIP 1.0), and EAU/EANM criteria, highlighting their superior prognostic value compared to RECIST and PCWG3, especially in metastatic castration-resistant prostate cancer (mCRPC). RECIP 1.0, initially validated for [¹⁷⁷Lu]Lu-PSMA-617, has demonstrated robust correlation with overall survival and interobserver reproducibility, improving risk stratification when combined with PSA. Quantitative parameters such as PSMA-VOL and TLP, key biomarkers for monitoring response and predicting outcomes, are analyzed. Furthermore, the evidence is reviewed by therapeutic modality, proposing practical recommendations on the optimal timing for PSMA-PET (baseline, intermediate, or delayed depending on treatment) and the need for standardized reporting (PROMISE, E-PSMA). The article also identifies current limitations: variability among radiopharmaceuticals, a lack of universal criteria, a scarcity of prospective studies, and challenges in multimodal integration with PSA and other biomarkers.

Objective: This study aimed to investigate the relationship between left ventricular phase analysis parameters and Peak Emptying Rate (PER) with ejection fraction (EF); to evaluate the role of PER in predicting early systolic dysfunction; and to examine how these parameters are affected by the severity of coronary artery disease (CAD) in patients with ischemia or infarction detected by gated myocardial perfusion scintigraphy (gMPS).

Materials and methods: Data from 430 patients who underwent myocardial perfusion scintigraphy for confirmed or suspected CAD were retrospectively analyzed. Based on perfusion defect scores, patients were categorized into three groups: normal (142 patients, SSS ≤ 3), ischemia (140 patients, SSS ≥ 4, reversible defect), and infarction (148 patients, SSS ≥ 4, fixed defect). Systolic and diastolic functional parameters of the left ventricle (EF, EDV, ESV, PER, PFR, TPFR) and synchrony indices (phase standard deviation [SD], histogram bandwidth [HBW]) were measured and compared across groups.

Results: EF values (65, 60, and 43%) and PER values (3.15, 2.94, and 2.06 s^-¹) progressively decreased from the normal to the ischemia and infarction groups, with statistically significant differences among groups (p < 0.001). Synchrony indices (SD and HBW) increased markedly, especially in the infarction group (mean HBW: 60.86-75.01 - 149.31; p < 0.001). In both ischemia and infarction groups, significant correlations were observed between synchrony (HBW) and systolic (EF, PER) as well as diastolic (PFR, TPFR) parameters, with the strongest associations in the infarction group (p < 0.001).

Conclusion: Progressive coronary artery disease is associated with worsening left ventricular systolic and diastolic function, along with impaired mechanical contraction synchrony. PER may serve as a valuable scintigraphic parameter for improving the diagnostic assessment of left ventricular systolic function.

Purpose: Evidence from randomized control trials supporting peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu DOTATATE in patients with lung neuroendocrine tumors (NETs) is limited. Real world data is needed.

Methods: We conducted a retrospective cohort study of patients with metastatic or unresectable lung carcinoid tumors treated with [177Lu]Lu-DOTATATE at a single Tertiary Oncology Center. Radiographic response (objective response rate - ORR; disease control rate - DCR), progression-free survival (PFS), overall survival (OS) and treatment toxicity (CTCAE v4) were assessed. Exploratory univariate Cox regression analyses were performed to evaluate predictors of PFS and OS.

Results: Twenty-two patients were included. The ORR was 31.8%, with DCR of 63.6%. Median PFS was 19 months (95% CI, 10-28), and median OS was 46 months (95% CI, 38-53). No grade 3/4 toxicities were observed. Symptom improvement was reported in 35.7% of symptomatic patients. Prior treatment with somatostatin analogues was significantly associated with longer PFS (HR 0.18, 95% CI, 0.05-0.62, p = 0.007), while respiratory symptoms were associated with shorter PFS (HR 5.01, 95% CI, 1.44-17.87, p = 0.012).

Conclusions: PRRT with [177Lu]Lu-DOTATATE appears to be safe and effective for patients with advanced lung carcinoids. These findings support PRRT as a valuable treatment option in selected patients, while highlighting the urgent need for prospective trials to establish its role in lung NETs.