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Giammarile F, Knoll P, Kunikowska J, Paez D, Estrada Lobato E, Mikhail-Lette M, Wahl R, Holmberg O, Abdel-Wahab M, Scott AM, Delgado Bolton RC. Guardians of precision: advancing radiation protection, safety, and quality systems in nuclear medicine. Eur J Nucl Med Mol Imaging 2024; 51:1498-1505. [PMID: 38319322 PMCID: PMC11043166 DOI: 10.1007/s00259-024-06633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND In the rapidly evolving field of nuclear medicine, the paramount importance of radiation protection, safety, and quality systems cannot be overstated. This document provides a comprehensive analysis of the intricate regulatory frameworks and guidelines, meticulously crafted and updated by national and international regulatory bodies to ensure the utmost safety and efficiency in the practice of nuclear medicine. METHODS We explore the dynamic nature of these regulations, emphasizing their adaptability in accommodating technological advancements and the integration of nuclear medicine with other medical and scientific disciplines. RESULTS Audits, both internal and external, are spotlighted for their pivotal role in assessing and ensuring compliance with established standards, promoting a culture of continuous improvement and excellence. We delve into the significant contributions of entities like the International Atomic Energy Agency (IAEA) and relevant professional societies in offering universally applicable guidelines that amalgamate the latest in scientific research, ethical considerations, and practical applicability. CONCLUSIONS The document underscores the essence of international collaborations in pooling expertise, resources, and insights, fostering a global community of practice where knowledge and innovations are shared. Readers will gain an in-depth understanding of the practical applications, challenges, and opportunities presented by these regulatory frameworks and audit processes. The ultimate goal is to inspire and inform ongoing efforts to enhance safety, quality, and effectiveness in nuclear medicine globally.
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Affiliation(s)
- Francesco Giammarile
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria.
| | - Peter Knoll
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Diana Paez
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Enrique Estrada Lobato
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Miriam Mikhail-Lette
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Richard Wahl
- Washington University in St Louis School of Medicine, St. Louis, USA
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ola Holmberg
- Department of Nuclear Safety and Security, Radiation Safety and Monitoring Section, International Atomic Energy Agency, Vienna, Austria
| | - May Abdel-Wahab
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), La Rioja, Logroño, Spain
- Servicio Cántabro de Salud, Santander, Spain
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Kunos CA, Martin ME, Georgiou MF, Kuker RA, Chauhan A. Leveraging Programmatic Collaboration for a Radiopharmaceutical Clinic. Cancers (Basel) 2024; 16:1396. [PMID: 38611074 PMCID: PMC11011188 DOI: 10.3390/cancers16071396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Radiation oncologists, radiopharmacists, nuclear medicine physicians, and medical oncologists have seen a renewed clinical interest in radiopharmaceuticals for the curative or the palliative treatment of cancer. To allow for the discovery and the clinical advancement of targeted radiopharmaceuticals, these stakeholders have reformed their trial efforts and remodeled their facilities to accommodate the obligations of a program centered upon radioactive investigational drug products. Now considered informally as drugs and not beam radiotherapy, radiopharmaceuticals can be more easily studied in the traditional clinical trial enterprise ranging from phase 0-I to phase III studies. Resources and physical facilities allocated to radiopharmaceuticals have brought forth new logistics and patient experience for safe and satisfactory drug delivery. The clinical use of theranostic agents-that is, diagnostic and therapeutic radionuclide pairs-has accelerated radiopharmaceutical development.
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Affiliation(s)
- Charles A. Kunos
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, 1475 NW 12th Avenue, Suite 1500, Miami, FL 33136, USA
| | - Molly E. Martin
- Department of Radiology, Division of Nuclear Medicine, University of Iowa Health Care, Iowa City, IA 52242, USA;
| | - Michalis F. Georgiou
- Department of Radiology, Division of Nuclear Medicine, University of Miami, Miami, FL 33136, USA
| | - Russ A. Kuker
- Department of Radiology, Division of Nuclear Medicine, University of Miami, Miami, FL 33136, USA
| | - Aman Chauhan
- Department of Medicine, Division of Medical Oncology, University of Miami, Miami, FL 33136, USA;
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Song J, Pang W, Yi H, Ji J, Ye X, Li L. Tumor and metastatic lymph nodes metabolic activity on 18F-FDG-PET/CT to predict progression-free survival in locally advanced cervical cancer. Abdom Radiol (NY) 2024; 49:975-984. [PMID: 38302763 DOI: 10.1007/s00261-023-04158-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The present study investigated the predictive diseases progression value of preoperative fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with local advanced cervical cancer (LACC). METHODS In total, 267 patients [median age 58 (range: 27-85) years old] with LACC underwent 18F-FDG PET/CT prior to any treatment. The maximum standardized uptake values (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesion and metastatic lymph nodes were measured on PET/CT and correlated with clinicopathological features and progression-free survival (PFS). RESULTS The median follow-up was 36.52 (range: 3.09-61.29) months. During the observation period, 80 (30.0%) patients exhibited disease progression. Univariate analysis showed that FIGO stage, concurrent chemoradiotherapy (CRT), serum level of carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag), primary tumor MTV (pMTV) and TLG (pTLG), lymph nodes SUVmax (nSUVmax) and TLG (nTLG), and total metabolic activity (sMTV, sTLG) were associated with PFS. nSUVmax ≥ 5.29, CEA ≥ 7.11 ng/ml and deficiency of concurrent CRT were independent risk factor for PFS (p = 0.006, p = 0.008, p = 0.014). The 3-year PFS for patients with high nSUVmax were 42.2% compared to 56.3% for low nSUVmax values. CONCLUSION Pretreatment cervical and lymph nodes metabolic parameters were associated with PFS in patients with LACC.
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Affiliation(s)
- Jinling Song
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Weiqiang Pang
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Heqing Yi
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Jianfeng Ji
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Xuemei Ye
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China
| | - Linfa Li
- Department of Nuclear Medicine, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology (JBZX-202003), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China.
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Raffa S, Lanfranchi F, Satragno C, Giannelli F, Marcenaro M, Coco A, Cena SE, Sofia L, Marini C, Mammoliti S, Levaggi A, Tagliafico AS, Sambuceti G, Barra S, Morbelli S, Belgioia L, Bauckneht M. The prognostic value of FIGO staging defined by combining MRI and [ 18F]FDG PET/CT in patients with locally advanced cervical cancer. Curr Probl Cancer 2023; 47:101007. [PMID: 37684197 DOI: 10.1016/j.currproblcancer.2023.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023]
Abstract
The last version of the FIGO classification recommended imaging tools to complete the clinical assessment of patients with cervical cancer. However, the preferable imaging approach is still unclear. We aimed to explore the prognostic power of Magnetic Resonance Imaging (MRI), contrast-enhanced Computed Tomography (ceCT), and [18F]-Fluorodeoxyglucose Positron Emission Tomography ([18F]FDG-PET)/CT in patients staged for locally advanced cervical cancer (LACC, FIGO stages IB3-IVA). Thirty-six LACC patients (mean age 55.47 ± 14.01, range 31-82) were retrospectively enrolled. All of them underwent MRI, ceCT and [18F]FDG-PET/CT before receiving concurrent chemoradiotherapy. A median dose of 45 Gy (range 42-50.4; 25-28 fractions, 5 fractions per week, 1 per day) was delivered through the external-beam radiation therapy (EBRT) on the pelvic area, while a median dose of 57.5 Gy (range 16-61.1; 25-28 fractions, 5 fractions per week, 1 per day) was administered on metastatic nodes. The median doses for brachytherapy treatment were 28 Gy (range 28-30; 4-5 fractions, 1 every other day). Six cycles of cisplatin or carboplatin were administered weekly. The study endpoints were recurrence-free survival (RFS) and overall survival (OS). Metastatic pelvic lymph nodes at MRI independently predicted RFS (HR 13.271, 95% CI 1.730-101.805; P = 0.027), while metastatic paraaortic lymph nodes at [18F]FDG-PET/CT independently predicted both RFS (HR 11.734, 95% CI 3.200-43.026; P = .005) and OS (HR 13.799, 95% CI 3.378-56.361; P < 0.001). MRI and [18F]FDG-PET/CT findings were incorporated with clinical evidences into the FIGO classification. With respect to the combination of clinical, MRI and ceCT data, the use of next-generation imaging (NGI) determined a stage migration in 10/36 (27.7%) of patients. Different NGI-based FIGO classes showed remarkably different median RFS (stage IIB: not reached; stage IIIC1: 44 months; stage IIIC2: 3 months; P < 0.001) and OS (stage IIB: not reached; stage IIIC1: not reached; stage IIIC2: 14 months; P < 0.001). A FIGO classification based on the combination of MRI and [18F]FDG-PET/CT might predict RFS and OS of LACC patients treated with concurrent chemoradiotherapy.
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Affiliation(s)
- Stefano Raffa
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Camilla Satragno
- Department of Experimental Medicine (DIMES), University of Genoa, Genova, Italy
| | - Flavio Giannelli
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michela Marcenaro
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Angela Coco
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | | | - Luca Sofia
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Cecilia Marini
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy; CNR, Institute of Molecular Bioimaging and Physiology (IBFM), Milano, Italy
| | - Serafina Mammoliti
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessia Levaggi
- Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy.; Radiologic Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Salvina Barra
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Silvia Morbelli
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Liliana Belgioia
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy.; Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy..
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Ming C, Bai X, Zhao L, Yu D, Wang X, Wu Y. RPL24 as a potential prognostic biomarker for cervical cancer treated by Cisplatin and concurrent chemoradiotherapy. Front Oncol 2023; 13:1131803. [PMID: 37920171 PMCID: PMC10619668 DOI: 10.3389/fonc.2023.1131803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 09/05/2023] [Indexed: 11/04/2023] Open
Abstract
Cervical carcinoma (CC) is the one of most common gynecologic cancers worldwide. The ribosomal proteins (RPs) are essential for ribosome assembly and function, and it has been verified that the abnormal expression of RPs was closely associated with tumorigenesis. In this study, we found that the RP large subunit 24 (RPL24) expression level was upregulated after the CC cell lines SiHa and HeLa were treated with Cisplatin (CDDP) in vitro. Simultaneously, a nude mouse xenograft model was used to examine the effect of RPL24 on tumor growth in vivo, which showed that overexpression of RPL24 can suppress tumor growth. Furthermore, we proved that RPL24 expression increased after CC patients were treated with concurrent chemoradiotherapy (CCRT), and the higher expression of RPL24 predicted a better prognosis using clinical data from 40 CC patients, verified via the Kaplan-Meier Plotter and LOGpc. These results revealed that RPL24 can be considered a potential biomarker to predict the prognosis of CC patients and assess CCRT efficacy.
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Affiliation(s)
- Cheng Ming
- Department of Oncology, Baotou Central Hospital, Inner Mongolia Medical University, Baotou, China
| | - Xuelian Bai
- Department of Oncology, Baotou Central Hospital, Baotou, China
| | - Lifeng Zhao
- Department of Oncology, Baotou Central Hospital, Baotou, China
| | - Dedong Yu
- Department of Oncology, Baotou Central Hospital, Baotou, China
| | - Xiaomin Wang
- Institute of Translational Medicine, Baotou Central Hospital, Baotou, China
| | - Yun Wu
- Department of Oncology, Baotou Central Hospital, Baotou, China
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Kaanders JHAM, Bussink J, Aarntzen EHJG, Braam P, Rütten H, van der Maazen RWM, Verheij M, van den Bosch S. [18F]FDG-PET-Based Personalized Radiotherapy Dose Prescription. Semin Radiat Oncol 2023; 33:287-297. [PMID: 37331783 DOI: 10.1016/j.semradonc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PET imaging with 2'-deoxy-2'-[18F]fluoro-D-glucose ([18F]FDG) has become one of the pillars in the management of malignant diseases. It has proven value in diagnostic workup, treatment policy, follow-up, and as prognosticator for outcome. [18F]FDG is widely available and standards have been developed for PET acquisition protocols and quantitative analyses. More recently, [18F]FDG-PET is also starting to be appreciated as a decision aid for treatment personalization. This review focuses on the potential of [18F]FDG-PET for individualized radiotherapy dose prescription. This includes dose painting, gradient dose prescription, and [18F]FDG-PET guided response-adapted dose prescription. The current status, progress, and future expectations of these developments for various tumor types are discussed.
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Affiliation(s)
- Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands..
| | - Johan Bussink
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Erik H J G Aarntzen
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Pètra Braam
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Marcel Verheij
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Sven van den Bosch
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
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Thorwarth D. Clinical use of positron emission tomography for radiotherapy planning - Medical physics considerations. Z Med Phys 2023; 33:13-21. [PMID: 36272949 PMCID: PMC10068574 DOI: 10.1016/j.zemedi.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/17/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
PET/CT imaging plays an increasing role in radiotherapy treatment planning. The aim of this article was to identify the major use cases and technical as well as medical physics challenges during integration of these data into treatment planning. Dedicated aspects, such as (i) PET/CT-based radiotherapy simulation, (ii) PET-based target volume delineation, (iii) functional avoidance to optimized organ-at-risk sparing and (iv) functionally adapted individualized radiotherapy are discussed in this article. Furthermore, medical physics aspects to be taken into account are summarized and presented in form of check-lists.
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Affiliation(s)
- Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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8
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Choi JW, Dean EA, Lu H, Thompson Z, Qi J, Krivenko G, Jain MD, Locke FL, Balagurunathan Y. Repeatability of metabolic tumor burden and lesion glycolysis between clinical readers. Front Immunol 2023; 14:994520. [PMID: 36875072 PMCID: PMC9975754 DOI: 10.3389/fimmu.2023.994520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023] Open
Abstract
The Metabolic Tumor Volume (MTV) and Tumor Lesion Glycolysis (TLG) has been shown to be independent prognostic predictors for clinical outcome in Diffuse Large B-cell Lymphoma (DLBCL). However, definitions of these measurements have not been standardized, leading to many sources of variation, operator evaluation continues to be one major source. In this study, we propose a reader reproducibility study to evaluate computation of TMV (& TLG) metrics based on differences in lesion delineation. In the first approach, reader manually corrected regional boundaries after automated detection performed across the lesions in a body scan (Reader M using a manual process, or manual). The other reader used a semi-automated method of lesion identification, without any boundary modification (Reader A using a semi- automated process, or auto). Parameters for active lesion were kept the same, derived from standard uptake values (SUVs) over a 41% threshold. We systematically contrasted MTV & TLG differences between expert readers (Reader M & A). We find that MTVs computed by Readers M and A were both concordant between them (concordant correlation coefficient of 0.96) and independently prognostic with a P-value of 0.0001 and 0.0002 respectively for overall survival after treatment. Additionally, we find TLG for these reader approaches showed concordance (CCC of 0.96) and was prognostic for over -all survival (p ≤ 0.0001 for both). In conclusion, the semi-automated approach (Reader A) provides acceptable quantification & prognosis of tumor burden (MTV) and TLG in comparison to expert reader assisted measurement (Reader M) on PET/CT scans.
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Affiliation(s)
- Jung W Choi
- Department of Diagnostic Imaging and Interventional Radiology, H Lee Moffitt Cancer Center, Tampa, FL, United States
| | - Erin A Dean
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee. Moffitt Cancer Center, Tampa, FL, United States.,Division of Hematology and Oncology, University of Florida, Gainesville, FL, , United States
| | - Hong Lu
- Cancer Physiology, H. Lee. Moffitt Cancer Center, Tampa, FL, United States.,Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zachary Thompson
- Biostatistics & Bioinformatics, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
| | - Jin Qi
- Cancer Physiology, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
| | - Gabe Krivenko
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
| | - Michael D Jain
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
| | - Frederick L Locke
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee. Moffitt Cancer Center, Tampa, FL, United States
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Wang X, Yang L, Wang Y. Meta-analysis of the diagnostic value of 18F-FDG PET/CT in the recurrence of epithelial ovarian cancer. Front Oncol 2022; 12:1003465. [PMID: 36419900 PMCID: PMC9676502 DOI: 10.3389/fonc.2022.1003465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/30/2022] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Ovarian cancer is the leading cause of cancer-related death among gynecologic malignancies. With much evidence suggesting that 18F-FDG PET/CT may be an excellent imaging test for the diagnosis of epithelial ovarian cancer recurrence, we conducted a systematic review and meta-analysis to summarize relevant studies and evaluate the accuracy and application value of 18F-FDG PET/CT in the diagnosis of recurrence of epithelial ovarian cancer. MATERIALS AND METHODS Clinical trials of 18F-FDG PET/CT for the diagnosis of recurrence of epithelial ovarian cancer were systematically searched in PubMed, Embase, Cochrane Library, Web of Science and OVID database. The relevant literature was searched until May 22, 2022. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the included original studies, and the meta-analysis was performed using a bivariate mixed-effects model and completed in Stata 15.0. RESULTS A total of 17 studies on 18F-FDG PET/CT for the diagnosis of epithelial ovarian cancer recurrence were included in this systematic review, involving 639 patients with epithelial ovarian cancer. Meta-analysis showed that the sensitivity, specificity and area under the curve of 18F-FDG PET/CT for the diagnosis of epithelial ovarian cancer recurrence were 0.88 (95% CI: 0.79 - 0.93), 0.89 (95% CI: 0.72 - 0.96) and 0.94 (95% CI: 0.91- 0.96), respectively. Subgroup analysis showed higher diagnostic efficacy in prospective studies than in retrospective studies, and no significant publication bias was observed in Deeks' funnel plot, with sensitivity analysis revealing the stability of results. Meta regression shows that the heterogeneity of this study comes from study type. CONCLUSION 18F-FDG PET/CT has good diagnostic value in the recurrence of epithelial ovarian cancer.
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Affiliation(s)
- Xiaoyan Wang
- School of Nursing, Hexi University, Zhangye, China
| | - Lifeng Yang
- School of Nursing, Hexi University, Zhangye, China
| | - Yan Wang
- Peking University First Hospital Ningxia Women and Children's Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, China
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10
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Ribeiro FM, Correia PMM, Santos AC, Veloso JFCA. A guideline proposal for mice preparation and care in 18F-FDG PET imaging. EJNMMI Res 2022; 12:49. [PMID: 35962869 PMCID: PMC9375789 DOI: 10.1186/s13550-022-00921-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/31/2022] [Indexed: 11/28/2022] Open
Abstract
The experimental outcomes of small-animal positron emission tomography (PET) imaging with 18F-labelled fluorodeoxyglucose (18F-FDG) can be particularly compromised by animal preparation and care. Several works intend to improve research reporting and amplify the quality and reliability of published research. Though these works provide valuable information to plan and conduct animal studies, manuscripts describe different methodologies—standardization does not exist. Consequently, the variation in details reported can explain the difference in the experimental results found in the literature. Additionally, the resources and guidelines defining protocols for small-animal imaging are scarce, making it difficult for researchers to obtain and compare accurate and reproducible data. Considering the selection of suitable procedures key to ensure animal welfare and research improvement, this paper aims to prepare the way for a future guideline on mice preparation and care for PET imaging with 18F-FDG. For this purpose, a global standard protocol was created based on recommendations and good practices described in relevant literature.
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Affiliation(s)
- F M Ribeiro
- Institute for Nanostructures, Nanomodelling and Nanofabrication (i3N), Department of Physics, University of Aveiro (DFis-UA), 3810-193, Aveiro, Portugal.
| | - P M M Correia
- Institute for Nanostructures, Nanomodelling and Nanofabrication (i3N), Department of Physics, University of Aveiro (DFis-UA), 3810-193, Aveiro, Portugal
| | - A C Santos
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine of the University of Coimbra (FMUC), Area of Environment Genetics and Oncobiology (CIMAGO), Center for Innovative Biomedicine and Biotechnology (CIBB), 3000-548, Coimbra, Portugal
| | - J F C A Veloso
- Institute for Nanostructures, Nanomodelling and Nanofabrication (i3N), Department of Physics, University of Aveiro (DFis-UA), 3810-193, Aveiro, Portugal
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Jiménez-Ortega E, Agüera R, Ureba A, Balcerzyk M, Wals-Zurita A, García-Gómez FJ, Leal A. Implications of the Harmonization of [18F]FDG-PET/CT Imaging for Response Assessment of Treatment in Radiotherapy Planning. Tomography 2022; 8:1097-1112. [PMID: 35448724 PMCID: PMC9031488 DOI: 10.3390/tomography8020090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this work is to present useful recommendations for the use of [18F]FDG-PET/CT imaging in radiotherapy planning and monitoring under different versions of EARL accreditation for harmonization of PET devices. A proof-of-concept experiment designed on an anthropomorphic phantom was carried out to establish the most suitable interpolation methods of the PET images in the different steps of the planning procedure. Based on PET/CT images obtained by using these optimal interpolations for the old EARL accreditation (EARL1) and for the new one (EARL2), the treatment plannings of representative actual clinical cases were calculated, and the clinical implications of the resulting differences were analyzed. As expected, EARL2 provided smaller volumes with higher resolution than EARL1. The increase in the size of the reconstructed volumes with EARL1 accreditation caused high doses in the organs at risk and in the regions adjacent to the target volumes. EARL2 accreditation allowed an improvement in the accuracy of the PET imaging precision, allowing more personalized radiotherapy. This work provides recommendations for those centers that intend to benefit from the new accreditation, EARL2, and can help build confidence of those that must continue working under the EARL1 accreditation.
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Affiliation(s)
- Elisa Jiménez-Ortega
- Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, 41009 Seville, Spain; (E.J.-O.); (R.A.); (M.B.)
- Instituto de Biomedicina de Sevilla, IBiS, 41013 Seville, Spain;
| | - Raquel Agüera
- Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, 41009 Seville, Spain; (E.J.-O.); (R.A.); (M.B.)
| | - Ana Ureba
- Instituto de Biomedicina de Sevilla, IBiS, 41013 Seville, Spain;
- Medical Radiation Physics, Department of Physics, Stockholm University, 114 21 Stockholm, Sweden
| | - Marcin Balcerzyk
- Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, 41009 Seville, Spain; (E.J.-O.); (R.A.); (M.B.)
- Centro Nacional de Aceleradores (CNA), Universidad de Sevilla, Junta de Andalucía, Consejo Superior de Investigaciones Científicas (CSIC), 41092 Seville, Spain
| | - Amadeo Wals-Zurita
- Hospital Universitario Virgen Macarena, Servicio de Radioterapia, 41009 Seville, Spain;
| | | | - Antonio Leal
- Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, 41009 Seville, Spain; (E.J.-O.); (R.A.); (M.B.)
- Instituto de Biomedicina de Sevilla, IBiS, 41013 Seville, Spain;
- Correspondence:
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12
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Lakomy DS, Yang J, Vedam S, Wang J, Lee B, Sobremonte A, Castillo P, Hughes N, Mohammadsaid M, Jhingran A, Klopp AH, Choi S, Fuller CD, Lin LL. Clinical implementation and initial experience with a 1.5 Tesla MR-linac for MR-guided radiotherapy for gynecologic cancer: An R-IDEAL stage 1/2a first in humans/feasibility study of new technology implementation. Pract Radiat Oncol 2022; 12:e296-e305. [PMID: 35278717 DOI: 10.1016/j.prro.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Magnetic resonance imaging-guided linear accelerator systems (MR-linacs) can facilitate the daily adaptation of radiotherapy plans. Here, we report our early clinical experience using an MR-linac for adaptive radiotherapy of gynecologic malignancies. METHODS AND MATERIALS Treatments were planned with an Elekta Monaco v5.4.01 and delivered by a 1.5 Tesla Elekta Unity MR-linac. The system offers a choice of daily adaptation based on either position (ATP) or shape (ATS) of the tumor and surrounding normal structures. The ATS approach has the option of manually editing the contours of tumors and surrounding normal structures before the plan is adapted. Here we documented the duration of each treatment fraction; set-up variability (assessed by isocenter shifts in each plan) between fractions; and, for quality assurance, calculated the percentage of plans meeting the γ-criterion of 3%/3-mm distance to agreement. Deformable accumulated dose calculations were used to compare accumulated versus planned dose for patient treated with exclusively ATP fractions. RESULTS Of the 10 patients treated with 90 fractions on the MR-linac, most received boost doses to recurrence in nodes or isolated tumors. Each treatment fraction lasted a median 32 minutes; fractions were shorter with ATP than with ATS (30 min vs 42 min, P<0.0001). The γ criterion for all fraction plans exceeded >90% (median 99.9%, range 92.4%-100%), i.e., all plans passed quality assurance testing. The average extent of isocenter shift was <0.5 cm in each axis. The accumulated dose to the gross tumor volume was within 5% of the reference plan for all ATP cases. Accumulated doses for lesions in the pelvic periphery were within <1% of the reference plan as opposed to -1.6% to -4.4% for central pelvic tumors. CONCLUSIONS The MR-linac is a reliable and clinically feasible tool for treating patients with gynecologic cancer.
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Affiliation(s)
- David S Lakomy
- Departments of Radiation Oncology; Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Jinzhong Yang
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sastry Vedam
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Wang
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Belinda Lee
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Angela Sobremonte
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pamela Castillo
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neil Hughes
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mustefa Mohammadsaid
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Dendl K, Koerber SA, Finck R, Mokoala KMG, Staudinger F, Schillings L, Heger U, Röhrich M, Kratochwil C, Sathekge M, Jäger D, Debus J, Haberkorn U, Giesel FL. 68Ga-FAPI-PET/CT in patients with various gynecological malignancies. Eur J Nucl Med Mol Imaging 2021; 48:4089-4100. [PMID: 34050777 PMCID: PMC8484099 DOI: 10.1007/s00259-021-05378-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE 68Ga-FAPI (fibroblast activation protein inhibitor) is a novel and highly promising radiotracer for PET/CT imaging. The aim of this retrospective analysis is to explore the potential of FAPI-PET/CT in gynecological malignancies. We assessed biodistribution, tumor uptake, and the influence of pre- or postmenopausal status on tracer accumulation in hormone-sensitive organs. Furthermore, a comparison with the current standard oncological tracer 18F-FDG was performed in selected cases. PATIENTS AND METHODS A total of 31 patients (median age 59.5) from two centers with several gynecological tumors (breast cancer; ovarian cancer; cervical cancer; endometrial cancer; leiomyosarcoma of the uterus; tubal cancer) underwent 68Ga-FAPI-PET/CT. Out of 31 patients, 10 received an additional 18F-FDG scan within a median time interval of 12.5 days (range 1-76). Tracer uptake was quantified by standardized uptake values (SUV)max and (SUV)mean, and tumor-to-background ratio (TBR) was calculated (SUVmax tumor/ SUVmean organ). Moreover, a second cohort of 167 female patients with different malignancies was analyzed regarding their FAPI uptake in normal hormone-responsive organs: endometrium (n = 128), ovary (n = 64), and breast (n = 147). These patients were categorized by age as premenopausal (<35 years; n = 12), postmenopausal (>65 years; n = 68), and unknown menstrual status (35-65 years; n = 87), followed by an analysis of FAPI uptake of the pre- and postmenopausal group. RESULTS In 8 out of 31 patients, the primary tumor was present, and all 31 patients showed lesions suspicious for metastasis (n = 81) demonstrating a high mean SUVmax in both the primary (SUVmax 11.6) and metastatic lesions (SUVmax 9.7). TBR was significantly higher in 68Ga-FAPI compared to 18F-FDG for distant metastases (13.0 vs. 5.7; p = 0.047) and by trend for regional lymph node metastases (31.9 vs 27.3; p = 0.6). Biodistribution of 68Ga-FAPI-PET/CT presented significantly lower uptake or no significant differences in 15 out of 16 organs, compared to 18F-FDG-PET/CT. The highest uptake of all primary lesions was obtained in endometrial carcinomas (mean SUVmax 18.4), followed by cervical carcinomas (mean SUVmax 15.22). In the second cohort, uptake in premenopausal patients differed significantly from postmenopausal patients in endometrium (11.7 vs 3.9; p < 0.0001) and breast (1.8 vs 1.0; p = 0.004), whereas no significant difference concerning ovaries (2.8 vs 1.6; p = 0.141) was observed. CONCLUSION Due to high tracer uptake resulting in sharp contrasts in primary and metastatic lesions and higher TBRs than 18F-FDG-PET/CT, 68Ga-FAPI-PET/CT presents a promising imaging method for staging and follow-up of gynecological tumors. The presence or absence of the menstrual cycle seems to correlate with FAPI accumulation in the normal endometrium and breast. This first investigation of FAP ligands in gynecological tumor entities supports clinical application and further research in this field.
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Affiliation(s)
- Katharina Dendl
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Rebecca Finck
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Kgomotso M G Mokoala
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Fabian Staudinger
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Lisa Schillings
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Dirk Jäger
- Department of Medical Oncology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany.
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany.
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14
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Give to Fryback what is Fryback's, and to new PET technologies what is new PET technologies'. Eur J Nucl Med Mol Imaging 2021; 48:2676-2677. [PMID: 34120202 DOI: 10.1007/s00259-021-05454-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
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