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Zamani-Siahkali N, Mirshahvalad SA, Farbod A, Divband G, Pirich C, Veit-Haibach P, Cook G, Beheshti M. SPECT/CT, PET/CT, and PET/MRI for Response Assessment of Bone Metastases. Semin Nucl Med 2024; 54:356-370. [PMID: 38172001 DOI: 10.1053/j.semnuclmed.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024]
Abstract
Recent developments in hybrid SPECT/CT systems and the use of cadmium-zinc-telluride (CZT) detectors have improved the diagnostic accuracy of bone scintigraphy. These advancements have paved the way for novel quantitative approaches to accurate and reproducible treatment monitoring of bone metastases. PET/CT imaging using [18F]F-FDG and [18F]F-NaF have shown promising clinical utility in bone metastases assessment and monitoring response to therapy and prediction of treatment response in a broad range of malignancies. Additionally, specific tumor-targeting tracers like [99mTc]Tc-PSMA, [68Ga]Ga-PSMA, or [11C]C- or [18F]F-Choline revealed high diagnostic performance for early assessment and prognostication of bone metastases, particularly in prostate cancer. PET/MRI appears highly accurate imaging modality, but has associated limitations notably, limited availability, more complex logistics and high installation costs. Advances in artificial intelligence (Al) seem to improve the accuracy of imaging modalities and provide an assistant role in the evaluation of treatment response of bone metastases.
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Affiliation(s)
- Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Abolfazl Farbod
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria; Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Gary Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria.
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2
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Cook GJR, Thorpe MP. Bone Metastases. Cancer J 2024; 30:202-209. [PMID: 38753755 DOI: 10.1097/ppo.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
ABSTRACT Bone metastases occur frequently in common malignancies such as breast and prostate cancer. They are responsible for considerable morbidity and skeletal-related events. Fortunately, there are now several systemic, focal, and targeted therapies that can improve quality and length of life, including radionuclide therapies. It is therefore important that bone metastases can be detected as early as possible and that treatment can be accurately and sensitively monitored. Several bone-specific and tumor-specific single-photon emission computed tomography and positron emission tomography molecular imaging agents are available, for detection and monitoring response to systemic therapeutics, as well as theranostic agents to confirm target expression and predict response to radionuclide therapies.
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Affiliation(s)
- Gary J R Cook
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Matthew P Thorpe
- Division of Nuclear Radiology, Department of Radiology, Mayo Clinic, Rochester, MN
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Ulaner GA, Vaz SC, Groheux D. Quarter-Century Transformation of Oncology: Positron Emission Tomography for Patients with Breast Cancer. PET Clin 2024; 19:147-162. [PMID: 38177052 DOI: 10.1016/j.cpet.2023.12.002] [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] [Indexed: 01/06/2024]
Abstract
PET radiotracers have become indispensable in the care of patients with breast cancer. 18F-fluorodeoxyglucose has become the preferred method of many oncologists for systemic staging of breast cancer at initial diagnosis, detecting recurrent disease, and for measuring treatment response after therapy. 18F-Sodium Fluoride is valuable for detection of osseous metastases. 18F-fluoroestradiol is now FDA-approved with multiple appropriate clinical uses. There are multiple PET radiotracers in clinical trials, which may add utility of PET imaging for patients with breast cancer in the future. This article will describe the advances during the last quarter century in PET for patients with breast cancer.
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Affiliation(s)
- Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Irvine, CA, USA; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, USA.
| | - Sofia Carrilho Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - David Groheux
- Nuclear Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France
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4
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Deng J, Yang J, Wang Y, Liu G, Chen Y. Comparison of the relative diagnostic performance of 68Ga-DOTA-IBA and 18F-NaF for the detection of bone metastasis. Front Oncol 2024; 14:1364311. [PMID: 38585006 PMCID: PMC10995215 DOI: 10.3389/fonc.2024.1364311] [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: 01/02/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose We aimed to compare the relative diagnostic efficacy of 68Ga-Labeled DOTA-ibandronic acid (68Ga-DOTA-IBA) to that of18F-NaF PET/CT as a mean of detecting bone metastases in patients with a range of cancer types. Methods This study retrospectively enrolled patients with bone metastases associated with various underlying malignancies. All patients underwent both 68Ga-DOTA-IBA and 18F-NaF PET/CT scans. Histopathology and follow-up CT or MRI imaging results were used as reference criteria, with a minimum follow-up period of 3 months. The maximum Standardized Uptake Value (SUVmax) and number of bone metastases were recorded. The Target-Background Ratio (TBR) was calculated along with the detection rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 68Ga-DOTA-IBA and 18F-NaF PET/CT imaging for overall and partial primary solid tumor bone metastases. Pearson chi-square test, McNemar test, and Kappa test was conducted to assess the correlation and consistency of diagnostic efficiency between the two imaging agents. Receiver Operating Characteristic curve (ROC curve) was performed to compare diagnostic performance and the area under the curve of the two imaging agents, determining optimal critical values for SUVmax and TBR in diagnosing bone metastasis. Differences in SUVmax and TBR values between the two imaging agents for detecting bone metastases were analyzed using the Wilcoxon signed rank test. The difference was statistically significant when P < 0.05. Results A total of 24 patients (13 women and 11 men) were included in this study, with a mean age of 52 (interquartile range, 49-64 years). The detection rate, sensitivity, specificity, PPV, NPV, accuracy, and AUC of 68Ga-DOTA-IBA and 18F-NaF PET/CT for bone metastases were 81%, 90%, 62%, 95%, 43%, 88%, 0.763, and 89%, 99%, 59%, 95%, 89%, 95%, 0.789, respectively. There was no significant difference between the two imaging methods (P < 0.01), and there was a significant correlation (X2=168.43, P < 0.001) and a strong consistency (Kappa=0.774,P < 0.001) between the diagnostic results of the two imaging agents. The SUVmax values of lesions measured by 68Ga-DOTA-IBA and 18F-NaF imaging in 22 patients with bone metastasis were 5.1 ± 5.4 and 19.6 ± 15.1, respectively, with statistically significant differences (P<0.05). The TBR values of the two imaging methods were 5.0 ± 5.0 and 6.7 ± 6.4, respectively, with statistically significant differences (P<0.05). The AUC of the SUVmax of 68Ga-DOTA-IBA and 18F-NaF curves were 0.824 and 0.862, respectively, with no statistically significant difference (P=0.490). No significant difference was found in the AUC of the TBR of 68Ga-DOTA-IBA and 18F-NaF (0.832 vs 0.890; P=0.248). Subgroup analysis showed significant correlation between the two imaging agents in the diagnosis of bone metastases in lung cancer and breast cancer, with consistent diagnostic results. However, in the diagnosis of bone metastases in prostate cancer, there was a significant difference (P<0.001) and lack of consistency (P=0.109). Conclusion The diagnostic efficacy of 68Ga-DOTA-IBA for bone metastasis lesions is comparable to that of 18F-NaF. This finding holds significant clinical importance in terms of diagnosis of bone metastasis and selecting treatment plans for patients with malignant tumors.
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Affiliation(s)
- Jia Deng
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Jian Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Yingwei Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Guangfu Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
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5
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Hazelton J, Kim S, Boerner JL, Podgorski I, Perk T, Cackowski F, Aoun HD, Heath EI. 18 F-sodium fluoride positron emission tomography quantitation of bone metastases in African American and non-African American men with metastatic prostate cancer. Prostate 2023; 83:1193-1200. [PMID: 37211866 PMCID: PMC10524638 DOI: 10.1002/pros.24578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 04/25/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Bone is the most common site of metastases in men with prostate cancer. The objective of this study was to explore potential racial differences in the distribution of tumor metastases in the axial and appendicular skeleton. METHODS We conducted a retrospective review of patients with metastatic prostate cancer to the bone as detected by 18 F-sodium fluoride positron emission tomography/computed tomography (18 F-NaF PET/CT) scans. In addition to describing patients' demographics and clinical characteristics, the metastatic bone lesions, and healthy bone regions were detected and quantified volumetrically using a quantitative imaging platform (TRAQinform IQ, AIQ Solutions). RESULTS Forty men met the inclusion criteria with 17 (42%) identifying as African Americans and 23 (58%) identifying as non-African Americans. Most of the patients had axial (skull, ribcage, and spine) disease. The location and the number of lesions in the skeleton of metastatic prostate cancer patients with low disease burden were not different by race. CONCLUSIONS In low-disease burden patients with metastatic prostate cancer, there were no overall differences by race in the location and number of lesions in axial or appendicular skeleton. Therefore, given equal access to molecular imaging, African Americans might derive similar benefits. Whether this holds true for patients with a higher disease burden or for other molecular imaging techniques is a topic for further study.
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Affiliation(s)
- Julian Hazelton
- Karmanos Cancer Institute and Imaging Division, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Seongho Kim
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Julie L Boerner
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Izabela Podgorski
- Karmanos Cancer Institute and Department of Pharmacology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Frank Cackowski
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Hussein D. Aoun
- Karmanos Cancer Institute and Imaging Division, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Elisabeth I. Heath
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Ganeshan D, Khatri G, Ali N, Avery R, Caserta MP, Chang SD, De Leon AD, Gupta RT, Lyshchik A, Michalski J, Nicola R, Pierorazio PM, Purysko AS, Smith AD, Taffel MT, Nikolaidis P. ACR Appropriateness Criteria® Staging of Renal Cell Carcinoma: 2022 Update. J Am Coll Radiol 2023; 20:S246-S264. [PMID: 37236747 DOI: 10.1016/j.jacr.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Renal cell carcinoma is a complex group of highly heterogenous renal tumors demonstrating variable biological behavior. Pretreatment imaging of renal cell carcinoma involves accurate assessment of the primary tumor, presence of nodal, and distant metastases. CT and MRI are the key imaging modalities used in the staging of renal cell carcinoma. Important imaging features that impact treatment include tumor extension into renal sinus and perinephric fat, involvement of pelvicalyceal system, infiltration into adrenal gland, involvement of renal vein and inferior vena cava, as well as the presence of metastatic adenopathy and distant metastases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Gaurav Khatri
- Panel Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Norman Ali
- The University of Texas MD Anderson Cancer Center, Houston, Texas, Primary care physician
| | - Ryan Avery
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Silvia D Chang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeff Michalski
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri; Commission on Radiation Oncology
| | - Refky Nicola
- SUNY Upstate Medical University, Syracuse, New York
| | - Phillip M Pierorazio
- Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania; American Urological Association
| | | | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Myles T Taffel
- New York University Langone Medical Center, New York, New York
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7
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Agrawal A, Natarajan A, Mithun S, Bakshi G, Joshi A, Murthy V, Menon S, Purandare N, Shah S, Puranik A, Choudhury S, Prakash G, Pal M, Maitre P, Prabhash K, Noronha V, Rangarajan V. Bone metastases in prostate cancer - Gallium-68-labeled prostate-specific membrane antigen or Fluorine 18 sodium fluoride PET/computed tomography - the better tracer? Nucl Med Commun 2022; 43:1225-1232. [PMID: 36345767 DOI: 10.1097/mnm.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective was to assess the roles of 68Ga-PSMA PET/CT and 18F-NaF PET/CT in evaluation of skeletal metastatic lesions in prostate cancer. METHODS Two hundred consecutive prostate cancer patients who had undergone 68Ga-PSMA PET/CT and 18F-NaF PET/CT at baseline evaluation (n = 80) and following suspected recurrence or disease progression (restaging) (n = 120) were analyzed retrospectively. RESULTS PSMA and NAF scans were positive for skeletal metastatic lesions in 67% (134 patients) and negative in 33% (66 patients). The scans were concordant in 80% (160 patients: 66 negative and 94 positive) and discordant in 20% (40 patients). Among 40 discordant results, 14 were baseline and 26 were restaging studies. PSMA detected more number of lesions in 11 (nine baseline and two restaging). These were true positive marrow or lytic metastatic lesions. NaF revealed more number of lesions in 29 (5 initial and 24 restaging). These were false positive on follow-up imaging. No statistical difference (P value = 0.7 by McNemar test) between the two scans for identifying absence or presence of at least one skeletal lesion was noted at baseline staging. CONCLUSION Though, both 18F-NaF and 68Ga-PSMA are excellent tracers for evaluation of skeletal metastases in prostate cancer, there is a distinct advantage of 68Ga-PSMA PET/CT due to detection of additional skeletal lesions and absence of false positive lesions. In addition, absence of PSMA avidity in healed metastases in the restaging setting opens up new avenue for assessment of response of skeletal metastases.
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Affiliation(s)
- Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai
| | - Aravintho Natarajan
- Department of Radiodiagnosis, Pondicherry Institute of Medical Sciences, Pondicherry and Departments of
| | | | | | - Amit Joshi
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai
| | | | - Santosh Menon
- Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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8
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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9
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Koa B, Raynor WY, Park PSU, Borja AJ, Singhal S, Kuang A, Zhang V, Werner TJ, Alavi A, Revheim ME. Feasibility of Global Assessment of Bone Metastases in Prostate Cancer with 18F-Sodium Fluoride-PET/Computed Tomography. PET Clin 2022; 17:631-640. [DOI: 10.1016/j.cpet.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Cook GJR. Imaging of Bone Metastases in Breast Cancer. Semin Nucl Med 2022; 52:531-541. [PMID: 35236615 PMCID: PMC7616189 DOI: 10.1053/j.semnuclmed.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/11/2022]
Abstract
Bone metastases are a common site of spread in advanced breast cancer and responsible for morbidity and high health care costs. Imaging contributes to staging and response assessment of the skeleton and has been instrumental in guiding patient management for several decades. Historically this has been with radiographs, computed tomography and bone scans. More recently, molecular and hybrid imaging methods have undergone significant development, including the addition of single photon emission computed tomography/computed tomography to the bone scan, positron emission tomography, with bone-specific and tumor-specific tracers, and magnetic resonance imaging with complementary functional diffusion-weighted imaging. These have allowed different aspects of the abnormal biology associated with bone metastases to be explored. There is ability to interrogate the bone microenvironment with bone-specific tracers and cancer cell characteristics with tumor-specific methods that complement morphological appearances on computed tomography or magnetic resonance imaging. Alongside the advent of novel, more effective and nuanced therapies for bone metastases in breast cancer, there is accumulating evidence that the developments in imaging allow more sensitive and specific detection of bone metastases as well as more accurate and earlier assessment of treatment response leading to improvements in patient management.
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Affiliation(s)
- Gary J R Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; King's College London & Guy's and St Thomas' PET Centre, St Thomas' Hospital, London, UK.
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11
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Kairemo K, Macapinlac HA. Oncology, bone metastases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Abstract
More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.
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13
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Keeling GP, Sherin B, Kim J, San Juan B, Grus T, Eykyn TR, Rösch F, Smith GE, Blower PJ, Terry SYA, T M de Rosales R. [ 68Ga]Ga-THP-Pam: A Bisphosphonate PET Tracer with Facile Radiolabeling and Broad Calcium Mineral Affinity. Bioconjug Chem 2021; 32:1276-1289. [PMID: 32786371 PMCID: PMC7611355 DOI: 10.1021/acs.bioconjchem.0c00401] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Calcium minerals such as hydroxyapatite (HAp) can be detected noninvasively in vivo using nuclear imaging agents such as [18F]NaF (available from cyclotrons), for positron emission tomography (PET) and 99mTc-radiolabeled bisphosphonates (BP; available from 99mTc generators for single photon emission computed tomography (SPECT) or scintigraphy). These two types of imaging agents allow detection of bone metastases (based on the presence of HAp) and vascular calcification lesions (that contain HAp and other calcium minerals). With the aim of developing a cyclotron-independent PET radiotracer for these lesions, with broad calcium mineral affinity and simple one-step radiolabeling, we developed [68Ga]Ga-THP-Pam. Radiolabeling with 68Ga is achieved using a mild single-step kit (5 min, room temperature, pH 7) to high radiochemical yield and purity (>95%). NMR studies demonstrate that Ga binds via the THP chelator, leaving the BP free to bind to its biological target. [68Ga]Ga-THP-Pam shows high stability in human serum. The calcium mineral binding of [68Ga]Ga-THP-Pam was compared in vitro to two other 68Ga-BPs which have been successfully evaluated in humans, [68Ga]Ga-NO2APBP and [68Ga]Ga-BPAMD, as well as [18F]NaF. Interestingly, we found that all 68Ga-BPs have a high affinity for a broad range of calcium minerals implicated in vascular calcification disease, while [18F]NaF is selective for HAp. Using healthy young mice as a model of metabolically active growing calcium mineral in vivo, we compared the pharmacokinetics and biodistribution of [68Ga]Ga-THP-Pam with [18F]NaF as well as [68Ga]NO2APBP. These studies revealed that [68Ga]Ga-THP-Pam has high in vivo affinity for bone tissue (high bone/muscle and bone/blood ratios) and fast blood clearance (t1/2 < 10 min) comparable to both [68Ga]NO2APBP and [18F]NaF. Overall, [68Ga]Ga-THP-Pam shows high potential for clinical translation as a cyclotron-independent calcium mineral PET radiotracer, with simple and efficient radiochemistry that can be easily implemented in any radiopharmacy.
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Affiliation(s)
- George P Keeling
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Billie Sherin
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Jana Kim
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Belinda San Juan
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Tilmann Grus
- Department of Nuclear Chemistry, Johannes Gutenberg University Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz, Germany
| | - Thomas R Eykyn
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Frank Rösch
- Department of Nuclear Chemistry, Johannes Gutenberg University Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz, Germany
| | - Gareth E Smith
- Theragnostics Ltd, 2 Arlington Square, Bracknell, Berkshire RG12 1WA, U.K
| | - Philip J Blower
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Samantha Y A Terry
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Rafael T M de Rosales
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
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14
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Kitajima K, Yamamoto S, Kawanaka Y, Komoto H, Shimatani K, Hanasaki T, Taguchi M, Nagasawa S, Yamada Y, Kanematsu A, Yamakado K. Assessment of the viability and treatment response of bone metastases in patients with metastatic castration-resistant prostate cancer using choline PET/CT. Medicine (Baltimore) 2021; 100:e26206. [PMID: 34115004 PMCID: PMC8202546 DOI: 10.1097/md.0000000000026206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate the clinical use of choline-PET/CT for discriminating viable progressive osteoblastic bone metastasis from benign osteoblastic change induced by the treatment effect and evaluating the response of bone metastasis to treatment in metastatic castration-resistant prostate cancer (mCRPC) patients. Thirty patients with mCRPC underwent a total of 56 11C-choline-PET/CT scans for restaging, because 4 patients received 1 scan and 26 had 2 scans. Using 2 (pre- and post-treatment) 11C-choline-PET/CT examinations per patient, treatment response was assessed according to European Organization for Research and Treatment of Cancer (EORTC) criteria in 20 situations, in which only bony metastases were observed on 11C-choline-PET/CT scans. Viable bone metastases and osteoblastic change induced by the treatment effect were identified in 53 (94.6%) and 29 (51.8%) of 56 11C-choline-PET/CT scans, respectively. In 27 cases (48.2%), 11C-choline-PET/CT scans could discriminate the 2 entities. The mean SUVmax of the metastatic bony lesions was 5.82 ± 3.21, 5.95 ± 3.96, 6.73 ± 5.04, and 7.91 ± 3.25 for the osteoblastic, osteolytic, mixed, and invisible types, respectively. Of the 20 situations analyzed, CMR, PMR, SMD, and PMD, as determined by the EORTC, were seen in 1, 2, 3, and 14 cases, respectively. Of the 13 patients with increasing PSA trend, all 13 showed PMD. Of the 2 patients with PSA response of <50%, both 2 showed SMD. Of the 5 patients with PSA response of ≥50%, 1 showed CMR, 2 showed PMR, 1 showed SMD, and 1 showed PMD. Choline-PET/CT is very useful to discriminate viable progressive osteoblastic bone metastasis from osteoblastic change, and assess treatment response of bone metastases in mCRPC.
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Affiliation(s)
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
| | | | | | | | | | | | - Seiji Nagasawa
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
| | - Yusuke Yamada
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
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15
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Liu F, Dong J, Shen Y, Yun C, Wang R, Wang G, Tan J, Wang T, Yao Q, Wang B, Li L, Mi J, Zhou D, Xiong F. Comparison of PET/CT and MRI in the Diagnosis of Bone Metastasis in Prostate Cancer Patients: A Network Analysis of Diagnostic Studies. Front Oncol 2021; 11:736654. [PMID: 34671558 PMCID: PMC8522477 DOI: 10.3389/fonc.2021.736654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Accurate diagnosis of bone metastasis status of prostate cancer (PCa) is becoming increasingly more important in guiding local and systemic treatment. Positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) have increasingly been utilized globally to assess the bone metastases in PCa. Our meta-analysis was a high-volume series in which the utility of PET/CT with different radioligands was compared to MRI with different parameters in this setting. MATERIALS AND METHODS Three databases, including Medline, Embase, and Cochrane Library, were searched to retrieve original trials from their inception to August 31, 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The methodological quality of the included studies was assessed by two independent investigators utilizing Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A Bayesian network meta-analysis was performed using an arm-based model. Absolute sensitivity and specificity, relative sensitivity and specificity, diagnostic odds ratio (DOR), and superiority index, and their associated 95% confidence intervals (CI) were used to assess the diagnostic value. RESULTS Forty-five studies with 2,843 patients and 4,263 lesions were identified. Network meta-analysis reveals that 68Ga-labeled prostate membrane antigen (68Ga-PSMA) PET/CT has the highest superiority index (7.30) with the sensitivity of 0.91 and specificity of 0.99, followed by 18F-NaF, 11C-choline, 18F-choline, 18F-fludeoxyglucose (FDG), and 18F-fluciclovine PET/CT. The use of high magnetic field strength, multisequence, diffusion-weighted imaging (DWI), and more imaging planes will increase the diagnostic value of MRI for the detection of bone metastasis in prostate cancer patients. Where available, 3.0-T high-quality MRI approaches 68Ga-PSMA PET/CT was performed in the detection of bone metastasis on patient-based level (sensitivity, 0.94 vs. 0.91; specificity, 0.94 vs. 0.96; superiority index, 4.43 vs. 4.56). CONCLUSIONS 68Ga-PSMA PET/CT is recommended for the diagnosis of bone metastasis in prostate cancer patients. Where available, 3.0-T high-quality MRI approaches 68Ga-PSMA PET/CT should be performed in the detection of bone metastasis.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yelong Shen
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Canhua Yun
- Department of Nuclear Medicine, The Second Hospital of Shandong University, Jinan, China
| | - Ruixiao Wang
- Department of Urology Surgery, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Ganggang Wang
- Department of Urology Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jiyang Tan
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Tao Wang
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Qun Yao
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jingyi Mi
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fei Xiong
- Department of Sports Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, China
- *Correspondence: Fei Xiong,
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16
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Theodoropoulos AS, Gkiozos I, Kontopyrgias G, Charpidou A, Kotteas E, Kyrgias G, Tolia M. Modern radiopharmaceuticals for lung cancer imaging with positron emission tomography/computed tomography scan: A systematic review. SAGE Open Med 2020; 8:2050312120961594. [PMID: 33062275 PMCID: PMC7534078 DOI: 10.1177/2050312120961594] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 08/27/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: In this study, we evaluated the use and the contribution of radiopharmaceuticals to the field of lung neoplasms imaging using positron emission tomography/computed tomography. Methods: We conducted review of the current literature at PubMed/MEDLINE until February 2020. The search language was English. Results: The most widely used radiopharmaceuticals are the following: Experimental/pre-clinical approaches: (18)F-Misonidazole (18F-MISO) under clinical development, D(18)F-Fluoro-Methyl-Tyrosine (18F-FMT), 18F-FAMT (L-[3-18F] (18)F-Fluorothymidine (18F-FLT)), (18)F-Fluoro-Azomycin-Arabinoside (18F-FAZA), (68)Ga-Neomannosylated-Human-Serum-Albumin (68Ga-MSA) (23), (68)Ga-Tetraazacyclododecane (68Ga-DOTA) (as theranostic agent), (11)C-Methionine (11C-MET), 18F-FPDOPA, ανβ3 integrin, 68Ga-RGD2, 64Cu-DOTA-RGD, 18F-Alfatide, Folate Radio tracers, and immuno-positron emission tomography radiopharmaceutical agents. Clinically approved procedures/radiopharmaceuticals agents: (18)F-Fluoro-Deoxy-Glucose (18F-FDG), (18)F-sodium fluoride (18F-NaF) (bone metastases), and (68)Ga-Tetraazacyclododecane (68Ga-DOTA). The quantitative determination and the change in radiopharmaceutical uptake parameters such as standard uptake value, metabolic tumor volume, total lesion glycolysis, FAZA tumor to muscle ratio, standard uptake value tumor to liver ratio, standard uptake value tumor to spleen ratio, standard uptake value maximum ratio, and the degree of hypoxia have prognostic and predictive (concerning the therapeutic outcome) value. They have been associated with the assessment of overall survival and disease free survival. With the positron emission tomography/computed tomography radiopharmaceuticals, the sensitivity and the specificity of the method have increased. Conclusion: In terms of lung cancer, positron emission tomography/computed tomography may have clinical application and utility (a) in personalizing treatment, (b) as a biomarker for the estimation of overall survival, disease free survival, and (c) apply a cost-effective patient approach because it reveals focuses of the disease, which are not found with the other imaging methods.
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Affiliation(s)
- Athanasios S Theodoropoulos
- Third Department of Medicine, Oncology Unit, School of Medicine, Sotiria General Hospital, University of Athens, Athens, Greece.,Interventional Department of Cardiology-Cardiac Catheterization Laboratory, Thriassio General Hospital of Elefsina, Athens, Greece
| | - Ioannis Gkiozos
- Third Department of Medicine, Oncology Unit, School of Medicine, Sotiria General Hospital, University of Athens, Athens, Greece
| | - Georgios Kontopyrgias
- Third Department of Medicine, Oncology Unit, School of Medicine, Sotiria General Hospital, University of Athens, Athens, Greece
| | - Adrianni Charpidou
- Third Department of Medicine, Oncology Unit, School of Medicine, Sotiria General Hospital, University of Athens, Athens, Greece
| | - Elias Kotteas
- Third Department of Medicine, Oncology Unit, School of Medicine, Sotiria General Hospital, University of Athens, Athens, Greece
| | - George Kyrgias
- Department of Radiotherapy/Radiation Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Biopolis, Larisa, Greece
| | - Maria Tolia
- Department of Radiotherapy/Radiation Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Biopolis, Larisa, Greece
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Abstract
Radiolabeled bisphosphonates were developed in the 1970s for scintigraphic functional imaging of the skeleton in benign and malignant disease. Tracers such as 99mTc-methylene diphosphonate, that map focal or global changes in mineralization in the skeleton qualitatively and quantitatively, have been the backbone of nuclear medicine imaging for decades. While competing technologies are evolving, new indications and improvements in scanner hardware, in particular hybrid imaging (e.g. single photon emission computed tomography combined with computed tomography), have allowed improved diagnostic accuracy and a continued role for radiolabeled bisphosphonate imaging in current practice.
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Affiliation(s)
- Gary J R Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
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18
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19
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Boers J, de Vries EFJ, Glaudemans AWJM, Hospers GAP, Schröder CP. Application of PET Tracers in Molecular Imaging for Breast Cancer. Curr Oncol Rep 2020; 22:85. [PMID: 32627087 PMCID: PMC7335757 DOI: 10.1007/s11912-020-00940-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Molecular imaging with positron emission tomography (PET) is a powerful tool to visualize breast cancer characteristics. Nonetheless, implementation of PET imaging into cancer care is challenging, and essential steps have been outlined in the international "imaging biomarker roadmap." In this review, we identify hurdles and provide recommendations for implementation of PET biomarkers in breast cancer care, focusing on the PET tracers 2-[18F]-fluoro-2-deoxyglucose ([18F]-FDG), sodium [18F]-fluoride ([18F]-NaF), 16α-[18F]-fluoroestradiol ([18F]-FES), and [89Zr]-trastuzumab. RECENT FINDINGS Technical validity of [18F]-FDG, [18F]-NaF, and [18F]-FES is established and supported by international guidelines. However, support for clinical validity and utility is still pending for these PET tracers in breast cancer, due to variable endpoints and procedures in clinical studies. Assessment of clinical validity and utility is essential towards implementation; however, these steps are still lacking for PET biomarkers in breast cancer. This could be solved by adding PET biomarkers to randomized trials, development of imaging data warehouses, and harmonization of endpoints and procedures.
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Affiliation(s)
- Jorianne Boers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Erik F J de Vries
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Carolina P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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20
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Cook GJR, Goh V. Molecular Imaging of Bone Metastases and Their Response to Therapy. J Nucl Med 2020; 61:799-806. [PMID: 32245899 DOI: 10.2967/jnumed.119.234260] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/30/2020] [Indexed: 12/18/2022] Open
Abstract
Bone metastases are common, especially in more prevalent malignancies such as breast and prostate cancer. They cause significant morbidity and draw on health-care resources. Molecular and hybrid imaging techniques, including SPECT/CT, PET/CT, and whole-body MRI with diffusion-weighted imaging, have improved diagnostic accuracy in staging the skeleton compared with previous standard imaging methods, allowing earlier tailored treatment. With the introduction of several effective treatment options, it is now even more important to detect and monitor response in bone metastases accurately. Conventional imaging, including radiographs, CT, MRI, and bone scintigraphy, are recognized as being insensitive and nonspecific for response monitoring in a clinically relevant time frame. Early reports of molecular and hybrid imaging techniques, as well as whole-body MRI, promise an earlier and more accurate prediction of response versus nonresponse but have yet to be adopted routinely in clinical practice. We summarize the role of new molecular and hybrid imaging methods, including SPECT/CT, PET/CT, and whole-body MRI. These modalities are associated with improvements in diagnostic accuracy for the staging and response assessment of skeletal metastases over standard imaging methods, being able to quantify biologic processes related to the bone microenvironment as well as tumor cells. The described improvements in the imaging of bone metastases and their response to therapy have led to adoption of some of these methods into routine clinical practice in some centers. These methods also provide a better way to assess the treatment response of bone metastases in clinical trials.
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Affiliation(s)
- Gary J R Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Vicky Goh
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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21
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Can 18F-NaF PET/CT before Autologous Stem Cell Transplantation Predict Survival in Multiple Myeloma? Cancers (Basel) 2020; 12:cancers12051335. [PMID: 32456181 PMCID: PMC7281312 DOI: 10.3390/cancers12051335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023] Open
Abstract
There is an unmet need for positron emission tomography (PET) radiotracers that can image bone disease in multiple myeloma (MM) in a more sensitive and specific way than the widely used 18F-fluorodeoxyglucose (18F-FDG). Sodium fluoride (18F-NaF) is a highly sensitive tracer of bone reconstruction, evolving as an important imaging agent for the assessment of malignant bone diseases. We attempted to investigate for the first time the prognostic significance of 18F-NaF PET/CT in newly diagnosed, symptomatic MM patients planned for autologous stem cell transplantation (ASCT). Forty-seven patients underwent dynamic and static PET/CT with 18F-NaF before treatment. After correlation with the respective findings on CT and 18F-FDG PET/CT that served as reference, the 18F-NaF PET findings were compared with established factors of high-risk disease, like cytogenetic abnormalities as well as bone marrow plasma cell infiltration rate. Furthermore, the impact of 18F-NaF PET/CT on progression-free survival (PFS) was analyzed. Correlation analysis revealed a moderate, significant correlation of the 18F-NaF parameters SUVaverage and K1 in reference tissue with bone marrow plasma cell infiltration rate. However, no significant correlation was observed regarding all other 18F-NaF PET parameters. Survival analysis revealed that patients with a pathologic 18F-NaF PET/CT have a shorter PFS (median = 36.2 months) than those with a physiologic scan (median = 55.6 months) (p = 0.02). Nevertheless, no quantitative 18F-NaF parameter could be shown to adversely affect PFS. In contrast, the respective analysis for quantitative dynamic 18F-FDG PET/CT revealed that the parameters SUVmax, fractional blood volume (VB), k3 and influx from reference tissue as well as SUVaverage from MM lesions had a significant negative impact on patient survival. The herein presented findings highlight the rather limited role of 18F-NaF PET/CT as a single PET approach in MM.
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22
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Targeting of radioactive platinum-bisphosphonate anticancer drugs to bone of high metabolic activity. Sci Rep 2020; 10:5889. [PMID: 32246003 PMCID: PMC7125202 DOI: 10.1038/s41598-020-62039-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/06/2020] [Indexed: 11/08/2022] Open
Abstract
Platinum-based chemotherapeutics exhibit excellent antitumor properties. However, these drugs cause severe side effects including toxicity, drug resistance, and lack of tumor selectivity. Tumor-targeted drug delivery has demonstrated great potential to overcome these drawbacks. Herein, we aimed to design radioactive bisphosphonate-functionalized platinum (195mPt-BP) complexes to confirm preferential accumulation of these Pt-based drugs in metabolically active bone. In vitro NMR studies revealed that release of Pt from Pt BP complexes increased with decreasing pH. Upon systemic administration to mice, Pt-BP exhibited a 4.5-fold higher affinity to bone compared to platinum complexes lacking the bone-seeking bisphosphonate moiety. These Pt-BP complexes formed less Pt-DNA adducts compared to bisphosphonate-free platinum complexes, indicating that in vivo release of Pt from Pt-BP complexes proceeded relatively slow. Subsequently, radioactive 195mPt-BP complexes were synthesized using 195mPt(NO3)2(en) as precursor and injected intravenously into mice. Specific accumulation of 195mPt-BP was observed at skeletal sites with high metabolic activity using micro-SPECT/CT imaging. Furthermore, laser ablation-ICP-MS imaging of proximal tibia sections confirmed that 195mPt BP co-localized with calcium in the trabeculae of mice tibia.
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23
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Taralli S, Caldarella C, Lorusso M, Scolozzi V, Altini C, Rubini G, Calcagni ML. Comparison between 18F-FDG and 18F-NaF PET imaging for assessing bone metastases in breast cancer patients: a literature review. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00363-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Maganty A, Turner RM, Yabes JG, Heron DE, Gingrich JR, Davies BJ, Jacobs BL. Increasing use of positron emission tomography among medicare beneficiaries undergoing radical cystectomy. Eur J Cancer Care (Engl) 2020; 29:e13230. [PMID: 32026559 DOI: 10.1111/ecc.13230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine factors associated with PET scan use in the pre-operative evaluation of patients diagnosed with bladder cancer. METHODS Using SEER-Medicare data, we identified bladder cancer patients who underwent radical cystectomy from 2006 to 2011 (n = 4,138). The primary outcome was PET scan use within 6 months before surgery. To examine predictors of PET scan use, we fit a mixed logit model with health service area as a random effect to account for patients nested within health service areas. We also calculated the adjusted probability of use over time and examined variation among the highest volume surgeons. RESULTS Among the 4,138 patients, 406 (10%) received a pre-operative PET scan. The adjusted probability of a patient undergoing a PET scan increased from 0.04 in 2004 to 0.10 in 2011 (p < .001). Among the 78 highest volume surgeons, there was significant variation in PET scan use (p < .001). Patients with non-urothelial histology, measurement of alkaline phosphatase levels, and receipt of neoadjuvant chemotherapy were more likely to receive PET scan (all p < .05). CONCLUSION Use of PET prior to radical cystectomy doubled over a 5-year period, suggesting its increased use in patients with muscle-invasive bladder cancer, particularly those with high-risk disease. Whether its use is warranted and improves patient outcomes is not clear and requires further studies.
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Affiliation(s)
- Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan G Yabes
- Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Turpin A, Girard E, Baillet C, Pasquier D, Olivier J, Villers A, Puech P, Penel N. Imaging for Metastasis in Prostate Cancer: A Review of the Literature. Front Oncol 2020; 10:55. [PMID: 32083008 PMCID: PMC7005012 DOI: 10.3389/fonc.2020.00055] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Initial staging and assessment of treatment activity in metastatic prostate cancer (PCa) patients is controversial. Indications for the various available imaging modalities are not well-established due to rapid advancements in imaging and treatment. Methods: We conducted a critical literature review of the main imaging abnormalities that suggest a diagnosis of metastasis in localized and locally advanced PCa or in cases of biological relapse. We also assessed the role of the various imaging modalities available in routine clinical practice for the detection of metastases and response to treatment in metastatic PCa patients. Results: In published clinical trials, the most commonly used imaging modalities for the detection and evaluation of therapeutic response are bone scan, abdominopelvic computed tomography (CT), and pelvic and bone magnetic resonance imaging (MRI). For the detection and follow-up of metastases during treatment, modern imaging techniques i.e., choline-positron emission tomography (PET), fluciclovine-PET, or Prostate-specific membrane antigen (PSMA)-PET provide better sensitivity and specificity. This is particularly the case of fluciclovine-PET and PSMA-PET in cases of biochemical recurrence with low values of prostate specific antigen. Conclusions: In routine clinical practice, conventional imaging still have a role, and communication between imagers and clinicians should be encouraged. Present and future clinical trials should use modern imaging methods to clarify their usage.
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Affiliation(s)
- Anthony Turpin
- Department of Medical Oncology, CHU Lille, Lille, France.,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Edwina Girard
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Clio Baillet
- Nuclear Medicine Department, CHU Lille, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRISTAL UMR CNRS 9189, Lille University, Villeneuve-d'Ascq, France
| | | | | | | | - Nicolas Penel
- Department of Medical Oncology, CHU Lille, Lille, France.,Medical Oncology Department, Centre Oscar Lambret, Lille, France
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26
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Sachpekidis C, Goldschmidt H, Dimitrakopoulou-Strauss A. Positron Emission Tomography (PET) Radiopharmaceuticals in Multiple Myeloma. Molecules 2019; 25:molecules25010134. [PMID: 31905752 PMCID: PMC6982887 DOI: 10.3390/molecules25010134] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 12/31/2022] Open
Abstract
Multiple myeloma (MM) is a plasma cell disorder, characterized by clonal proliferation of malignant plasma cells in the bone marrow. Bone disease is the most frequent feature and an end-organ defining indicator of MM. In this context, imaging plays a pivotal role in the management of the malignancy. For several decades whole-body X-ray survey (WBXR) has been applied for the diagnosis and staging of bone disease in MM. However, the serious drawbacks of WBXR have led to its gradual replacement from novel imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT). PET/CT, with the tracer 18F-fluorodeoxyglucose (18F-FDG), is now considered a powerful diagnostic tool for the detection of medullary and extramedullary disease at the time of diagnosis, a reliable predictor of survival as well as the most robust modality for treatment response evaluation in MM. On the other hand, 18F-FDG carries its own limitations as a radiopharmaceutical, including a rather poor sensitivity for the detection of diffuse bone marrow infiltration, a relatively low specificity, and the lack of widely applied, established criteria for image interpretation. This has led to the development of several alternative PET tracers, some of which with promising results regarding MM detection. The aim of this review article is to outline the major applications of PET/CT with different radiopharmaceuticals in the clinical practice of MM.
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Affiliation(s)
- Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, 69120 Heidelberg, Germany;
- Correspondence: or ; Tel.: +49-6221-42-2478; Fax: +49-6221-42-2476
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital Heidelberg and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany;
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27
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Ahuja K, Sotoudeh H, Galgano SJ, Singh R, Gupta N, Gaddamanugu S, Choudhary G. 18F-Sodium Fluoride PET: History, Technical Feasibility, Mechanism of Action, Normal Biodistribution, and Diagnostic Performance in Bone Metastasis Detection Compared with Other Imaging Modalities. J Nucl Med Technol 2019; 48:9-16. [PMID: 31811067 DOI: 10.2967/jnmt.119.234336] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
The skeleton is the third most common site for metastasis overall, after the lungs and liver. Accurate diagnosis of osseous metastasis is critical for initial staging, treatment planning, restaging, treatment monitoring, and survival prediction. Currently, 99mTc-methylene diphosphonate whole-body scanning is the cornerstone of imaging to detect osseous metastasis. Although 18F-sodium fluoride (18F-NaF) was one of the oldest medical tracers for this purpose, it was replaced by other tracers because of their better physical properties, until recently. Continued development of PET scanners has opened a new era for 18F-NaF, and given its higher sensitivity, there have been increasing applications in imaging. In this review, we will discuss the history, technical aspects, radiobiology, and biodistribution of this tracer. Finally, we compare the accuracy of 18F-NaF PET with other conventional imaging methods for detection of osseous metastasis.
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Affiliation(s)
- Kriti Ahuja
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Houman Sotoudeh
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ramandeep Singh
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Nishant Gupta
- Department of Radiology, Columbia University at Bassett Healthcare, Cooperstown, New York
| | | | - Gagandeep Choudhary
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Scheetz L, Park KS, Li Q, Lowenstein PR, Castro MG, Schwendeman A, Moon JJ. Engineering patient-specific cancer immunotherapies. Nat Biomed Eng 2019; 3:768-782. [PMID: 31406259 PMCID: PMC6783331 DOI: 10.1038/s41551-019-0436-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/03/2019] [Indexed: 02/06/2023]
Abstract
Research into the immunological processes implicated in cancer has yielded a basis for the range of immunotherapies that are now considered the fourth pillar of cancer treatment (alongside surgery, radiotherapy and chemotherapy). For some aggressive cancers, such as advanced non-small-cell lung carcinoma, combination immunotherapies have resulted in unprecedented treatment efficacy for responding patients, and have become frontline therapies. Individualized immunotherapy, enabled by the identification of patient-specific mutations, neoantigens and biomarkers, and facilitated by advances in genomics and proteomics, promises to broaden the responder patient population. In this Perspective, we give an overview of immunotherapies leveraging engineering approaches, including the design of biomaterials, delivery strategies and nanotechnology solutions, for the realization of individualized cancer treatments such as nanoparticle vaccines customized with neoantigens, cell therapies based on patient-derived dendritic cells and T cells, and combinations of theranostic strategies. Developments in precision cancer immunotherapy will increasingly rely on the adoption of engineering principles.
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Affiliation(s)
- Lindsay Scheetz
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Kyung Soo Park
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Qiao Li
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Pedro R Lowenstein
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
- Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Maria G Castro
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
- Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Anna Schwendeman
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - James J Moon
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, USA.
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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29
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Velez EM, Desai B, Jadvar H. Treatment Response Assessment of Skeletal Metastases in Prostate Cancer with 18F-NaF PET/CT. Nucl Med Mol Imaging 2019; 53:247-252. [PMID: 31456857 PMCID: PMC6694323 DOI: 10.1007/s13139-019-00601-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/24/2019] [Accepted: 06/18/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To determine the utility of 18F-sodium fluoride positron emission tomography-computed tomography (18F-NaF PET/CT) in the imaging assessment of therapy response in men with osseous-only metastatic prostate cancer. METHODS In this Institutional Review Board-approved single institution retrospective investigation, we evaluated 21 18F-NaF PET/CT scans performed in 14 patients with osseous metastatic disease from prostate cancer and no evidence of locally recurrent or soft-tissue metastatic disease who received chemohormonal therapy. Imaging-based qualitative and semi-quantitative parameters were defined and compared with changes in serum PSA level. RESULTS Qualitative and semi-quantitative image-based assessments demonstrated > 80% concordance with good correlation (SUVmax κ = 0.71, SUVavg κ = 0.62, SUVsum κ = 0.62). Moderate correlation (κ = 0.43) was found between SUVmax and PSA-based treatment response assessments. There was no statistically significant correlation between PSA-based disease progression and semi-quantitative parameters. Qualitative imaging assessment was moderately correlated (κ = 0.52) with PSA in distinguishing responders and non-responders. CONCLUSION 18F-NaF PET/CT is complementary to biochemical monitoring in patients with bone-only metastases from prostate cancer which can be helpful in subsequent treatment management decisions.
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Affiliation(s)
- Erik M. Velez
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar St., CSC 102, Los Angeles, CA 90033 USA
| | - Bhushan Desai
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar St., CSC 102, Los Angeles, CA 90033 USA
| | - Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar St., CSC 102, Los Angeles, CA 90033 USA
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30
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Vaz S, Usmani S, Gnanasegaran G, Van den Wyngaert T. Molecular imaging of bone metastases using bone targeted tracers. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 63:112-128. [PMID: 31286752 DOI: 10.23736/s1824-4785.19.03198-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Molecular imaging using bone targeted tracers has been used in clinical practice for almost fifty years and still plays an essential role in the diagnosis and follow-up of bone metastases. It includes both [99mTc]bisphosphonates for bone scan and [18F]NaF for positron emission tomography/computed tomography (PET/CT) which are very sensitive to detect osteoblastic activity, but it is important to consider several aspects to increase the specificity of reported findings (such as specific tracer characteristics and mechanism of action, patient's clinical history, common metastatic patterns, changes after treatment, limitations of the technique, variations and pitfalls). This will enable useful information for clinical management being provided in the report. Furthermore, iatrogenic skeletal adverse events are common and they should also be identified, as they have impact on patient's quality of life. This review makes a brief summary of the mechanism of action of bone targeted tracers, followed by a discussion of classic patterns of bone metastasis, treatment response assessment and iatrogenic skeletal complications. The value of hybrid imaging techniques with bone targeted tracers, including single photon emission computed tomography and PET/CT is also explored. The final part summarizes new bone targeted tracers with superior imaging characteristics that are being developed, and which may further enhance the applications of radionuclide bone imaging.
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Affiliation(s)
- Sofia Vaz
- Department of Nuclear Medicine Radiopharmacology, Champalimaud Center for the Unknown, Lisbon, Portugal -
| | - Sharjeel Usmani
- Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khaitan, Kuwait City, Kuwait
| | | | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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31
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Azad GK, Taylor BP, Green A, Sandri I, Swampillai A, Harries M, Kristeleit H, Mansi J, Goh V, Cook GJR. Prediction of therapy response in bone-predominant metastatic breast cancer: comparison of [ 18F] fluorodeoxyglucose and [ 18F]-fluoride PET/CT with whole-body MRI with diffusion-weighted imaging. Eur J Nucl Med Mol Imaging 2019; 46:821-830. [PMID: 30506455 PMCID: PMC6450846 DOI: 10.1007/s00259-018-4223-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/19/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To compare [18F]-fluorodeoxyglucose (FDG) and [18F]-sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) with whole-body magnetic resonance with diffusion-weighted imaging (WB-MRI), for endocrine therapy response prediction at 8 weeks in bone-predominant metastatic breast cancer. PATIENTS AND METHODS Thirty-one patients scheduled for endocrine therapy had up to five bone metastases measured [FDG, NaF PET/CT: maximum standardized uptake value (SUVmax); WB-MRI: median apparent diffusion coefficient (ADCmed)] at baseline and 8 weeks. To detect the flare phenomenon, a 12-week NaF PET/CT was also performed if 8-week SUVmax increased. A 25% parameter change differentiated imaging progressive disease (PD) from non-PD and was compared to a 24-week clinical reference standard and progression-free survival (PFS). RESULTS Twenty-two patients (median age, 58.6 years, range, 40-79 years) completing baseline and 8-week imaging were included in the final analysis. Per-patient % change in NaF SUVmax predicted 24-week clinical PD with sensitivity, specificity and accuracy of 60, 73.3, and 70%, respectively. For FDG SUVmax the results were 0, 100, and 76.2% and for ADCmed, 0, 100 and 72.2%, respectively. PFS < 24 weeks was associated with % change in SUVmax (NaF: 41.7 vs. 0.7%, p = 0.039; FDG: - 4.8 vs. - 28.6%, p = 0.005) but not ADCmed (- 0.5 vs. 10.1%, p = 0.098). Interlesional response heterogeneity occurred in all modalities and NaF flare occurred in seven patients. CONCLUSIONS FDG PET/CT and WB-MRI best predicted clinical non-PD and both FDG and NaF PET/CT predicted PFS < 24 weeks. Lesional response heterogeneity occurs with all modalities and flare is common with NaF PET/CT.
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Affiliation(s)
- Gurdip K Azad
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin P Taylor
- Department of Oncology, Guys and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Adrian Green
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ines Sandri
- Department of Oncology, Guys and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Angela Swampillai
- Department of Oncology, Guys and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Mark Harries
- Department of Oncology, Guys and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Hartmut Kristeleit
- Department of Oncology, Guys and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Janine Mansi
- Department of Oncology, Guys and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Vicky Goh
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gary J R Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- King's College London & Guy's and St Thomas' PET Centre, St Thomas' Hospital, London, UK.
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32
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Raynor WY, Al-Zaghal A, Zadeh MZ, Seraj SM, Alavi A. Metastatic Seeding Attacks Bone Marrow, Not Bone: Rectifying Ongoing Misconceptions. PET Clin 2019; 14:135-144. [PMID: 30420215 DOI: 10.1016/j.cpet.2018.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Conventional modalities, such as bone scintigraphy, are commonly used to assess osseous abnormalities in skeletal metastasis. Fluorine-18 (18F)-sodium fluoride (NaF) PET similarly portrays osteoblastic activity but with improved spatial and contrast resolution and more accurate anatomic localization. However, these modalities rely on indirect evidence for tumor activity. PET imaging with 18F-fluorodeoxyglucose (FDG) and tumor-specific tracers may have an increased role by directly portraying the metabolic activity of cancer cells, which are often seeded in bone marrow and cause osseous disease after initial latency. This article describes the utility and limitations of these modalities in assessing skeletal metastases.
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Affiliation(s)
- William Y Raynor
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Radiology, Drexel University College of Medicine, 230 N Broad Street, Philadelphia, PA 19102, USA
| | - Abdullah Al-Zaghal
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mahdi Zirakchian Zadeh
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Siavash Mehdizadeh Seraj
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Abstract
Bone is the most common site of metastases from advanced breast cancer. Whole-body bone scintigraphy has been most frequently used in the process of managing cancer patients; its advantage is that it provides rapid whole-body imaging for screening of osteoblastic or sclerotic/mixed bone metastases at reasonable cost. Recent advanced techniques, such as single-photon emission computed tomography (SPECT)/CT, quantitative analysis, and bone scan index, contribute to better understanding of the disease state. More recent advances in machines and PET drugs improve the staging of the skeleton with higher sensitivity and specificity.
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34
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Jadvar H, Colletti PM. 18F-NaF/ 223RaCl 2 theranostics in metastatic prostate cancer: treatment response assessment and prediction of outcome. Br J Radiol 2018; 91:20170948. [PMID: 29630398 PMCID: PMC6475949 DOI: 10.1259/bjr.20170948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/03/2018] [Accepted: 04/01/2018] [Indexed: 12/15/2022] Open
Abstract
Theranostics refers to companion agents with identical or similar structure targeted to a specific biological entity for imaging and treatment. Although the concept has a long history with radioiodine in thyroidology, but it has experienced remarkable recent renaissance in management of neuroendocrine tumors and prostate cancer. Bone scintigraphy based on osteoblastic reaction and targeted radionuclide therapy with the alpha-particle calcium-mimetic agent, 223RaCl2, also form a theranostic model for imaging and treatment of osseous metastatic disease. Since the regulatory approval of 223RaCl2 in 2013, there has been accumulating evidence on the potential use of 18F-NaF PET scintigraphy in the assessment of response and prediction of outcome in males with metastatic castrate-resistant prostate cancer who undergo 223RaCl2 therapy. We review the 18F-NaF/223RaCl2 as theranostic companion in the management of prostate cancer with emphasis on the utility of 18F-NaF and other relevant PET radiotracers in the therapy response and prognosis assessments.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patrick M Colletti
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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35
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Targeted Therapy With Anaplastic Lymphoma Kinase Inhibitor (Alectinib) in Adolescent Metastatic Non–Small Cell Lung Carcinoma. Clin Nucl Med 2018; 43:752-754. [DOI: 10.1097/rlu.0000000000002220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Cook GJ, Goh V. Functional and Hybrid Imaging of Bone Metastases. J Bone Miner Res 2018; 33:961-972. [PMID: 29665140 PMCID: PMC7616187 DOI: 10.1002/jbmr.3444] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/02/2018] [Accepted: 04/06/2018] [Indexed: 12/21/2022]
Abstract
Bone metastases are common, cause significant morbidity, and impact on healthcare resources. Although radiography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy have frequently been used for staging the skeleton, these methods are insensitive and nonspecific for monitoring treatment response in a clinically relevant time frame. We summarize several recent reports on new functional and hybrid imaging methods including single photon emission CT/CT, positron emission tomography/CT, and whole-body MRI with diffusion-weighted imaging. These modalities generally show improvements in diagnostic accuracy for staging and response assessment over standard imaging methods, with the ability to quantify biological processes related to the bone microenvironment as well as tumor cells. As some of these methods are now being adopted into routine clinical practice and clinical trials, further evaluation with comparative studies is required to guide optimal and cost-effective clinical management of patients with skeletal metastases. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Gary Jr Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom
- King's College London and Guy's & St Thomas' PET Centre, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom
- Radiology Department, Guy's & St Thomas' Hospitals, London SE1 7EH, United Kingdom
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37
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Peterson LM, O'Sullivan J, Wu QV, Novakova-Jiresova A, Jenkins I, Lee JH, Shields A, Montgomery S, Linden HM, Gralow J, Gadi VK, Muzi M, Kinahan P, Mankoff D, Specht JM. Prospective Study of Serial 18F-FDG PET and 18F-Fluoride PET to Predict Time to Skeletal-Related Events, Time to Progression, and Survival in Patients with Bone-Dominant Metastatic Breast Cancer. J Nucl Med 2018; 59:1823-1830. [PMID: 29748233 DOI: 10.2967/jnumed.118.211102] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/30/2018] [Indexed: 12/16/2022] Open
Abstract
Assessing therapy response of breast cancer bone metastases is challenging. In retrospective studies, serial 18F-FDG PET was predictive of time to skeletal-related events (tSRE) and time to progression (TTP). 18F-NaF PET improves bone metastasis detection compared with bone scanning. We prospectively tested 18F-FDG PET and 18F-NaF PET to predict tSRE, TTP, and overall survival (OS) in patients with bone-dominant metastatic breast cancer (MBC). Methods: Patients with bone-dominant MBC were imaged with 18F-FDG PET and 18F-NaF PET before starting new therapy (scan1) and again at a range of times centered around approximately 4 mo later (scan2). Maximum standardized uptake value (SUVmax) and lean body mass adjusted standardized uptake (SULpeak) were recorded for a single index lesion and up to 5 most dominant lesions for each scan. tSRE, TTP, and OS were assessed exclusive of the PET images. Univariate Cox regression was performed to test the association between clinical endpoints and 18F-FDG PET and 18F-NaF PET measures. mPERCIST (Modified PET Response Criteria in Solid Tumors) were also applied. Survival curves for mPERCIST compared response categories of complete response+partial response+stable disease versus progressive disease for tSRE, TTP, and OS. Results: Twenty-eight patients were evaluated. Higher 18F-FDG SULpeak at scan2 predicted shorter time to tSRE (P = <0.001) and TTP (P = 0.044). Higher 18F-FDG SUVmax at scan2 predicted a shorter time to tSRE (P = <0.001). A multivariable model using 18F-FDG SUVmax of the index lesion at scan1 plus the difference in SUVmax of up to 5 lesions between scans was predictive for tSRE and TTP. Among 24 patients evaluable by 18F-FDG PET mPERCIST, tSRE and TTP were longer in responders (complete response, partial response, or stable disease) than in nonresponders (progressive disease) (P = 0.007, 0.028, respectively), with a trend toward improved survival (P = 0.1). An increase in the uptake between scans of up to 5 lesions by 18F-NaF PET was associated with longer OS (P = 0.027). Conclusion: Changes in 18F-FDG PET parameters during therapy are predictive of tSRE and TTP, but not OS. mPERCIST evaluation in bone lesions may be useful in assessing response to therapy and is worthy of evaluation in multicenter, prospective trials. Serial 18F-NaF PET was associated with OS but was not useful for predicting TTP or tSRE in bone-dominant MBC.
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Affiliation(s)
- Lanell M Peterson
- Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Janet O'Sullivan
- Department of Statistics, University College Cork, Cork, Ireland
| | - Qian Vicky Wu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Isaac Jenkins
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jean H Lee
- Department of Radiology, University of Washington, Seattle, Washington
| | - Andrew Shields
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Hannah M Linden
- Division of Medical Oncology, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Julie Gralow
- Division of Medical Oncology, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Vijayakrishna K Gadi
- Division of Medical Oncology, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, Washington
| | - Paul Kinahan
- Department of Radiology, University of Washington, Seattle, Washington
| | - David Mankoff
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer M Specht
- Division of Medical Oncology, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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38
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Accuracy of 18F-NaF PET/CT in bone metastasis detection and its effect on patient management in patients with breast carcinoma. Nucl Med Commun 2018; 39:325-333. [DOI: 10.1097/mnm.0000000000000807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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39
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18F-Fluoride PET/CT tumor burden quantification predicts survival in breast cancer. Oncotarget 2018; 8:36001-36011. [PMID: 28415595 PMCID: PMC5482633 DOI: 10.18632/oncotarget.16418] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/14/2017] [Indexed: 12/30/2022] Open
Abstract
Purpose In bone-metastatic breast cancer patients, there are no current imaging biomarkers to identify which patients have worst prognosis. The purpose of our study was to investigate if skeletal tumor burden determined by 18F-Fluoride PET/CT correlates with clinical outcomes and may help define prognosis throughout the course of the disease. Results Bone metastases were present in 49 patients. On multivariable analysis, skeletal tumor burden was significantly and independently associated with overall survival (p < 0.0001) and progression free-survival (p < 0.0001). The simple presence of bone metastases was associated with time to bone event (p = 0.0448). Materials and Methods We quantified the skeletal tumor burden on 18F-Fluoride PET/CT images of 107 female breast cancer patients (40 for primary staging and the remainder for restaging after therapy). Clinical parameters, primary tumor characteristics and skeletal tumor burden were correlated to overall survival, progression free-survival and time to bone event. The median follow-up time was 19.5 months. Conclusions 18F-Fluoride PET/CT skeletal tumor burden is a strong independent prognostic imaging biomarker in breast cancer patients.
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40
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Hicks RJ. The Injustice of Being Judged by the Errors of Others: The Tragic Tale of the Battle for PET Reimbursement. J Nucl Med 2018; 59:418-420. [DOI: 10.2967/jnumed.117.206953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/05/2018] [Indexed: 11/16/2022] Open
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41
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Blake GM, Puri T, Siddique M, Frost ML, Moore AEB, Fogelman I. Site specific measurements of bone formation using [ 18F] sodium fluoride PET/CT. Quant Imaging Med Surg 2018. [PMID: 29541623 DOI: 10.21037/qims.2018.01.02] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dynamic positron emission tomography (PET) imaging with fluorine-18 labelled sodium fluoride ([18F]NaF) allows the quantitative assessment of regional bone formation by measuring the plasma clearance of fluoride to bone at any site in the skeleton. Today, hybrid PET and computed tomography (CT) dual-modality systems (PET/CT) are widely available, and [18F]NaF PET/CT offers a convenient non-invasive method of studying bone formation at the important osteoporotic fracture sites at the hip and spine, as well as sites of pure cortical or trabecular bone. The technique complements conventional measurements of bone turnover using biochemical markers or bone biopsy as a tool to investigate new therapies for osteoporosis, and has a potential role as an early biomarker of treatment efficacy in clinical trials. This article reviews methods of acquiring and analyzing dynamic [18F]NaF PET/CT scan data, and outlines a simplified approach combining venous blood sampling with a series of short (3- to 5-minute) static PET/CT scans acquired at different bed positions to estimate [18F]NaF plasma clearance at multiple sites in the skeleton with just a single injection of tracer.
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Affiliation(s)
- Glen M Blake
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Tanuj Puri
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Musib Siddique
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Michelle L Frost
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Amelia E B Moore
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, UK
| | - Ignac Fogelman
- Nuclear Medicine Department, King's College London, Guy's Campus, London, UK
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Gareen IF, Hillner BE, Hanna L, Makineni R, Duan F, Shields AF, Subramaniam RM, Siegel BA. Hospice Admission and Survival After 18F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry. J Nucl Med 2017; 59:427-433. [PMID: 29284672 DOI: 10.2967/jnumed.117.205120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/20/2017] [Indexed: 12/27/2022] Open
Abstract
We have previously reported that PET using 18F-fluoride (NaF PET) for assessment of osseous metastatic disease was associated with substantial changes in intended management in Medicare beneficiaries participating in the National Oncologic PET Registry (NOPR). Here, we use Medicare administrative data to examine the association between NaF PET results and hospice claims within 180 d and 1-y survival. Methods: We classified NOPR NaF PET results linked to Medicare claims by imaging indication (initial staging [IS]; detection of suspected first osseous metastasis [FOM]; suspected progression of osseous metastasis [POM]; or treatment monitoring [TM]) and type of cancer (prostate, lung, breast, or other). Results were classified as definitely positive scan findings versus probably positive scan findings versus negative scan findings for osseous metastasis for IS and FOM; more extensive disease versus no change or less extensive disease for POM; and worse prognosis versus no change or better prognosis for TM, based on the postscan assessment. Our study included 21,167 scans obtained from 2011 to 2014 of consenting NOPR participants aged 65 y or older. Results: The relative risk of hospice claims within 180 d of a NaF PET scan was 2.0-7.5 times higher for patients with evidence of new or progressing osseous metastasis than for those without, depending on indication and cancer type (all P < 0.008). The percentage difference in hospice claims for those with a finding of new or more advanced osseous disease ranged from 3.9% for IS prostate patients to 28% for FOM lung patients. Six-month survival was also associated with evidence of new or increased osseous disease; risk of death was 1.8-5.1 times as likely (all P ≤ 0.0001), with percentage differences of approximately 30% comparing positive and negative scans in patients with lung cancer imaged for IS or FOM. Conclusion: Our analyses demonstrated that NaF PET scan results are highly associated with subsequent hospice claims and, ultimately, with patient survival. NaF PET provides important information on the presence of osseous metastasis and prognosis to assist patients and their physicians when making decisions on whether to select palliative care and transition to hospice or whether to continue treatment.
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Affiliation(s)
- Ilana F Gareen
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island .,Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Bruce E Hillner
- Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Rajesh Makineni
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Fenghai Duan
- Center for Statistical Sciences, Brown University, Providence, Rhode Island.,Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Anthony F Shields
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Rathan M Subramaniam
- Division of Nuclear Medicine, Department of Radiology, and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Barry A Siegel
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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Hillner BE, Hanna L, Makineni R, Duan F, Shields AF, Subramaniam RM, Gareen I, Siegel BA. Intended Versus Inferred Treatment After 18F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry. J Nucl Med 2017; 59:421-426. [PMID: 29191854 DOI: 10.2967/jnumed.117.205047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/23/2017] [Indexed: 11/16/2022] Open
Abstract
We have previously reported that PET with 18F-fluoride (NaF PET) for assessment of osseous metastatic disease led to changes in intended management in a substantial fraction of patients with prostate or other types of cancer participating in the National Oncologic PET Registry. This study was performed to assess the concordance of intended patient management after NaF PET and inferred management based on analysis of Medicare claims. Methods: We analyzed linked post-NaF PET data of consenting National Oncologic PET Registry participants age 65 y or older from 2011 to 2014 and their corresponding Medicare claims. Post-NaF PET treatment plans, including combinations of 2 modes of therapy, were assessed for their concordance with clinical actions inferred from Medicare claims. NaF PET studies were stratified by indication (initial staging [IS] or suspected first osseous metastasis [FOM]) and cancer type (prostate, lung, or other cancers). Agreement was assessed between post-NaF PET intended management plans for treatment (surgery, radiotherapy, or systemic therapy) within 90 d for lung and 180 d for prostate or other cancers, and for watching (the absence of treatment claims for ≥60 d) as compared with claims-inferred care. Results: Actions after 9,898 scans were assessed. After NaF PET for IS, there was claims agreement for planned surgery in 76.0% (19/25) lung, 75.4% (98/130) other cancers, and 58.9% (298/506) prostate cancer. Claims confirmed chemotherapy plans after NaF PET done for IS or FOM in 81.0% and 73.5% for lung cancer (n = 148 and 136) and 69.4% and 67.5% for other cancers (n = 111 and 228). For radiotherapy plans, agreement ranged from 80.0% to 84.4% after IS and 68.4% to 74.0% for suspected FOM. Concordance was greatest for androgen deprivation therapy (ADT) (86.0%, n = 308) alone or combined with radiotherapy in prostate cancer IS (80.8%, n = 517). In prostate FOM, the concordance across all treatment plans was lower if the patients had ADT claims within 180 d before NaF PET. Agreement with nontreatment plans was high for FOM (87.2% in other cancers and 78.6% if no prior ADT in prostate) and low after IS (40.7%-62.5%). Conclusion: Concordance of post-NaF PET plans and claims was substantial and higher overall for IS than for FOM.
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Affiliation(s)
- Bruce E Hillner
- Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lucy Hanna
- The Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Rajesh Makineni
- The Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Fenghai Duan
- The Center for Statistical Sciences, Brown University, Providence, Rhode Island.,Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Anthony F Shields
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Rathan M Subramaniam
- Division of Nuclear Medicine, Department of Radiology, and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ilana Gareen
- The Center for Statistical Sciences, Brown University, Providence, Rhode Island.,Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; and
| | - Barry A Siegel
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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Affiliation(s)
- Lingzhou Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiangyang Shi
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, People’s Republic of China
- CQM-Centro de Química da Madeira, Universidade da Madeira, Funchal, Portugal
| | - Jinhua Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Kougioumtzopoulou A, Zygogianni A, Liakouli Z, Kypraiou E, Kouloulias V. The role of radiotherapy in bone metastases: A critical review of current literature. Eur J Cancer Care (Engl) 2017. [PMID: 28631284 DOI: 10.1111/ecc.12724] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiotherapy is considered the treatment of choice for painful bone metastases. However, novel modalities of radiotherapy have emerged in the concept of oligometastasic disease. In addition, the increase of overall survival of patients with bone metastatic disease in the last decades due to systemic treatments has issued the silent topic of re-irradiation. The aim of this manuscript was to present a current thorough search of relevant literature. Originally, 6,087 articles revealed from PubMed database related to radiotherapy and bone metastases. The first objective was to identify prospective randomised phase III studies dealing with bone metastases and which treated primary with radiotherapy. Abstracts and non-English citations were excluded. Twenty-three phase III clinical trials, 17 prospective studies and eight meta-analysis/systemic reviews matching with these criteria, were identified. Eleven randomised studies were comparing single dose fraction to multi-fraction schedules of radiotherapy. The overall response rates and complete response rates were not significant between the two arms. Re-irradiations rates were significantly higher for the single dose fraction arms. Stereotactic radiotherapy showed excellent tumour control rates more than 80%. All trials showed the equivalence of either single or multi-fractionated radiotherapy for metastatic bone lesions. Stereotactic irradiation is feasible and safe for oligometastatic disease. However, it seems that the single fraction of 8 Gy is superior to 4 Gy, in terms of efficacy.
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Affiliation(s)
- A Kougioumtzopoulou
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Zygogianni
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Z Liakouli
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Kypraiou
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - V Kouloulias
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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46
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Etchebehere E, Brito AE, Rezaee A, Langsteger W, Beheshti M. Therapy assessment of bone metastatic disease in the era of 223radium. Eur J Nucl Med Mol Imaging 2017; 44:84-96. [DOI: 10.1007/s00259-017-3734-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 02/05/2023]
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47
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Wassberg C, Lubberink M, Sörensen J, Johansson S. Repeatability of quantitative parameters of 18F-fluoride PET/CT and biochemical tumour and specific bone remodelling markers in prostate cancer bone metastases. EJNMMI Res 2017; 7:42. [PMID: 28508284 PMCID: PMC5432456 DOI: 10.1186/s13550-017-0289-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/08/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose 18F-fluoride PET/CT exhibits high sensitivity to delineate and measure the extent of bone metastatic disease in patients with prostate cancer. 18F-fluoride PET/CT could potentially replace traditional bone scintigraphy in clinical routine and trials. However, more studies are needed to assess repeatability and biological uptake variation. The aim of this study was to perform test-retest analysis of quantitative PET-derived parameters and blood/serum bone turnover markers at the same time point. Ten patients with prostate cancer and verified bone metastases were prospectively included. All underwent two serial 18F-fluoride PET/CT at 1 h post-injection. Up to five dominant index lesions and whole-body 18F-fluoride skeletal tumour burden were recorded per patient. Lesion-based PET parameters were SUVmax, SUVmean and functional tumour volume applying a VOI with 50% threshold (FTV50%). The total skeletal tumour burden, total lesion 18F-fluoride (TLF), was calculated using a threshold of SUV of ≥15. Blood/serum biochemical bone turnover markers obtained at the time of each PET were PSA, ALP, S-osteocalcin, S-beta-CTx, 1CTP and BAP. Results A total of 47 index lesions and a range of 2–122 bone metastases per patient were evaluated. Median time between 18F-fluoride PET/CT was 7 days (range 6–8 days). Repeatability coefficients were for SUVmax 26%, SUVmean 24%, FTV50% for index lesions 23% and total skeletal tumour burden (TLF) 35%. Biochemical bone marker repeatability coefficients were for PSA 19%, ALP 23%, S-osteocalcin 18%, S-beta-CTx 22%, 1CTP 18% and BAP 23%. Conclusions Quantitative 18F-fluoride uptake and simultaneous biochemical bone markers measurements are reproducible for prostate cancer metastases and show similar magnitude in test-retest variation.
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Affiliation(s)
- Cecilia Wassberg
- Department of Surgical Sciences, Section of Nuclear Medicine and PET, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences, Section of Nuclear Medicine and PET, Uppsala, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences, Section of Nuclear Medicine and PET, Uppsala, Sweden. .,PET Centre, Uppsala University Hospital, Entrance 79, 5th floor, S-75185, Uppsala, Sweden.
| | - Silvia Johansson
- Department of Immunology, Genetics and Pathology, Section of Oncology, Uppsala University, Uppsala, Sweden
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48
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Assessment of skeletal tumour burden on 18F-NaF PET/CT using a new quantitative method. Nucl Med Commun 2017; 38:325-332. [DOI: 10.1097/mnm.0000000000000654] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Langsteger W, Rezaee A, Pirich C, Beheshti M. 18F-NaF-PET/CT and 99mTc-MDP Bone Scintigraphy in the Detection of Bone Metastases in Prostate Cancer. Semin Nucl Med 2016; 46:491-501. [DOI: 10.1053/j.semnuclmed.2016.07.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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50
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Joseph P, Ishai A, Mani V, Kallend D, Rudd JHF, Fayad ZA, Tawakol A. Short-term changes in arterial inflammation predict long-term changes in atherosclerosis progression. Eur J Nucl Med Mol Imaging 2016; 44:141-150. [DOI: 10.1007/s00259-016-3524-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/12/2016] [Indexed: 01/05/2023]
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