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Mansouri Z, Salimi Y, Akhavanallaf A, Shiri I, Teixeira EPA, Hou X, Beauregard JM, Rahmim A, Zaidi H. Deep transformer-based personalized dosimetry from SPECT/CT images: a hybrid approach for [ 177Lu]Lu-DOTATATE radiopharmaceutical therapy. Eur J Nucl Med Mol Imaging 2024; 51:1516-1529. [PMID: 38267686 PMCID: PMC11043201 DOI: 10.1007/s00259-024-06618-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Accurate dosimetry is critical for ensuring the safety and efficacy of radiopharmaceutical therapies. In current clinical dosimetry practice, MIRD formalisms are widely employed. However, with the rapid advancement of deep learning (DL) algorithms, there has been an increasing interest in leveraging the calculation speed and automation capabilities for different tasks. We aimed to develop a hybrid transformer-based deep learning (DL) model that incorporates a multiple voxel S-value (MSV) approach for voxel-level dosimetry in [177Lu]Lu-DOTATATE therapy. The goal was to enhance the performance of the model to achieve accuracy levels closely aligned with Monte Carlo (MC) simulations, considered as the standard of reference. We extended our analysis to include MIRD formalisms (SSV and MSV), thereby conducting a comprehensive dosimetry study. METHODS We used a dataset consisting of 22 patients undergoing up to 4 cycles of [177Lu]Lu-DOTATATE therapy. MC simulations were used to generate reference absorbed dose maps. In addition, MIRD formalism approaches, namely, single S-value (SSV) and MSV techniques, were performed. A UNEt TRansformer (UNETR) DL architecture was trained using five-fold cross-validation to generate MC-based dose maps. Co-registered CT images were fed into the network as input, whereas the difference between MC and MSV (MC-MSV) was set as output. DL results are then integrated to MSV to revive the MC dose maps. Finally, the dose maps generated by MSV, SSV, and DL were quantitatively compared to the MC reference at both voxel level and organ level (organs at risk and lesions). RESULTS The DL approach showed slightly better performance (voxel relative absolute error (RAE) = 5.28 ± 1.32) compared to MSV (voxel RAE = 5.54 ± 1.4) and outperformed SSV (voxel RAE = 7.8 ± 3.02). Gamma analysis pass rates were 99.0 ± 1.2%, 98.8 ± 1.3%, and 98.7 ± 1.52% for DL, MSV, and SSV approaches, respectively. The computational time for MC was the highest (~2 days for a single-bed SPECT study) compared to MSV, SSV, and DL, whereas the DL-based approach outperformed the other approaches in terms of time efficiency (3 s for a single-bed SPECT). Organ-wise analysis showed absolute percent errors of 1.44 ± 3.05%, 1.18 ± 2.65%, and 1.15 ± 2.5% for SSV, MSV, and DL approaches, respectively, in lesion-absorbed doses. CONCLUSION A hybrid transformer-based deep learning model was developed for fast and accurate dose map generation, outperforming the MIRD approaches, specifically in heterogenous regions. The model achieved accuracy close to MC gold standard and has potential for clinical implementation for use on large-scale datasets.
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Affiliation(s)
- Zahra Mansouri
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | - Yazdan Salimi
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | - Azadeh Akhavanallaf
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | - Eliluane Pirazzo Andrade Teixeira
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | - Xinchi Hou
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Mathieu Beauregard
- Cancer Research Centre and Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, QC, Canada
| | - Arman Rahmim
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland.
- Department of Nuclear Medicine, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, Netherlands.
- Department of Nuclear Medicine, University of Southern Denmark, DK-500, Odense, Denmark.
- University Research and Innovation Center, Óbuda University, Budapest, Hungary.
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Schürrle SB, Eberlein U, Ansquer C, Beauregard JM, Durand-Gasselin L, Grønbæk H, Haug A, Hicks RJ, Lenzo NP, Navalkissoor S, Nicolas GP, Pais B, Volteau M, Wild D, McEwan A, Lassmann M. Dosimetry and pharmacokinetics of [ 177Lu]Lu-satoreotide tetraxetan in patients with progressive neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06682-1. [PMID: 38528164 DOI: 10.1007/s00259-024-06682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/08/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE To evaluate the dosimetry and pharmacokinetics of the novel radiolabelled somatostatin receptor antagonist [177Lu]Lu-satoreotide tetraxetan in patients with advanced neuroendocrine tumours (NETs). METHODS This study was part of a phase I/II trial of [177Lu]Lu-satoreotide tetraxetan, administered at a median cumulative activity of 13.0 GBq over three planned cycles (median activity/cycle: 4.5 GBq), in 40 patients with progressive NETs. Organ absorbed doses were monitored at each cycle using patient-specific dosimetry; the cumulative absorbed-dose limits were set at 23.0 Gy for the kidneys and 1.5 Gy for bone marrow. Absorbed dose coefficients (ADCs) were calculated using both patient-specific and model-based dosimetry for some patients. RESULTS In all evaluated organs, maximum [177Lu]Lu-satoreotide tetraxetan uptake was observed at the first imaging timepoint (4 h after injection), followed by an exponential decrease. Kidneys were the main route of elimination, with a cumulative excretion of 57-66% within 48 h following the first treatment cycle. At the first treatment cycle, [177Lu]Lu-satoreotide tetraxetan showed a median terminal blood half-life of 127 h and median ADCs of [177Lu]Lu-satoreotide tetraxetan were 5.0 Gy/GBq in tumours, 0.1 Gy/GBq in the bone marrow, 0.9 Gy/GBq in kidneys, 0.2 Gy/GBq in the liver and 0.8 Gy/GBq in the spleen. Using image-based dosimetry, the bone marrow and kidneys received median cumulative absorbed doses of 1.1 and 10.8 Gy, respectively, after three cycles. CONCLUSION [177Lu]Lu-satoreotide tetraxetan showed a favourable dosimetry profile, with high and prolonged tumour uptake, supporting its acceptable safety profile and promising efficacy. TRIAL REGISTRATION NCT02592707. Registered October 30, 2015.
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Affiliation(s)
| | - Uta Eberlein
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | - Henning Grønbæk
- Department of Hepatology & Gastroenterology, ENETS Centre of Excellence, Aarhus University Hospital and Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Alexander Haug
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Rodney J Hicks
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Central Clinical School, the Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Nat P Lenzo
- GenesisCare, East Fremantle, WA, Australia
- Department of Medicine, Curtin University, Perth, WA, Australia
| | - Shaunak Navalkissoor
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Guillaume P Nicolas
- Division of Nuclear Medicine, ENETS Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Ben Pais
- SRT-Biomedical B.V, Soest, Netherlands.
- Ariceum Therapeutics GmbH, Berlin, Germany.
| | | | - Damian Wild
- Division of Nuclear Medicine, ENETS Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | | | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
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Wild D, Grønbæk H, Navalkissoor S, Haug A, Nicolas GP, Pais B, Ansquer C, Beauregard JM, McEwan A, Lassmann M, Pennestri D, Volteau M, Lenzo NP, Hicks RJ. A phase I/II study of the safety and efficacy of [ 177Lu]Lu-satoreotide tetraxetan in advanced somatostatin receptor-positive neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2023; 51:183-195. [PMID: 37721581 PMCID: PMC10684626 DOI: 10.1007/s00259-023-06383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/02/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE We present the results of an open-label, phase I/II study evaluating the safety and efficacy of the novel somatostatin receptor (SSTR) antagonist [177Lu]Lu-satoreotide tetraxetan in 40 patients with previously treated, progressive neuroendocrine tumours (NETs), in which dosimetry was used to guide maximum administered activity. METHODS This study was conducted in two parts. Part A consisted of 15 patients who completed three cycles of [177Lu]Lu-satoreotide tetraxetan at a fixed administered activity and peptide amount per cycle (4.5 GBq/300 µg). Part B, which included 25 patients who received one to five cycles of [177Lu]Lu-satoreotide tetraxetan, evaluated different administered activities (4.5 or 6.0 GBq/cycle) and peptide amounts (300, 700, or 1300 μg/cycle), limited to a cumulative absorbed radiation dose of 23 Gy to the kidneys and 1.5 Gy to the bone marrow. RESULTS Median cumulative administered activity of [177Lu]Lu-satoreotide tetraxetan was 13.0 GBq over three cycles (13.1 GBq in part A and 12.9 GBq in part B). Overall, 17 (42.5%) patients experienced grade ≥ 3 treatment‑related adverse events; the most common were lymphopenia, thrombocytopenia, and neutropenia. No grade 3/4 nephrotoxicity was observed. Two patients developed myeloid neoplasms considered treatment related by the investigator. Disease control rate for part A and part B was 94.7% (95% confidence interval [CI]: 82.3-99.4), and overall response rate was 21.1% (95% CI: 9.6-37.3). CONCLUSION [177Lu]Lu-satoreotide tetraxetan, administered at a median cumulative activity of 13.0 GBq over three cycles, has an acceptable safety profile with a promising clinical response in patients with progressive, SSTR-positive NETs. A 5-year long-term follow-up study is ongoing. TRIAL REGISTRATION ClinicalTrials.gov, NCT02592707. Registered October 30, 2015.
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Affiliation(s)
- Damian Wild
- Division of Nuclear Medicine, ENETS Centre of Excellence, University Hospital Basel, Basel, Switzerland.
| | - Henning Grønbæk
- Department of Hepatology & Gastroenterology, ENETS Centre of Excellence, Aarhus University Hospital and Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Shaunak Navalkissoor
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Alexander Haug
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Guillaume P Nicolas
- Division of Nuclear Medicine, ENETS Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Ben Pais
- SRT-Biomedical B.V., Soest, Netherlands
- Ariceum Therapeutics GmbH, Berlin, Germany
| | | | | | | | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Nat P Lenzo
- GenesisCare, East Fremantle, Australia
- Department of Medicine, Curtin University, Perth, Australia
| | - Rodney J Hicks
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
- Department of Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia
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Fizazi K, Herrmann K, Krause BJ, Rahbar K, Chi KN, Morris MJ, Sartor O, Tagawa ST, Kendi AT, Vogelzang N, Calais J, Nagarajah J, Wei XX, Koshkin VS, Beauregard JM, Chang B, Ghouse R, DeSilvio M, Messmann RA, de Bono J. Health-related quality of life and pain outcomes with [ 177Lu]Lu-PSMA-617 plus standard of care versus standard of care in patients with metastatic castration-resistant prostate cancer (VISION): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2023; 24:597-610. [PMID: 37269841 PMCID: PMC10641914 DOI: 10.1016/s1470-2045(23)00158-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND In VISION, the prostate-specific membrane antigen (PSMA)-targeted radioligand therapy lutetium-177 [177Lu]Lu-PSMA-617 (vipivotide tetraxetan) improved radiographic progression-free survival and overall survival when added to protocol-permitted standard of care in patients with metastatic castration-resistant prostate cancer. Here, we report additional health-related quality of life (HRQOL), pain, and symptomatic skeletal event results. METHODS This multicentre, open-label, randomised, phase 3 trial was conducted at 84 cancer centres in nine countries in North America and Europe. Eligible patients were aged 18 years or older; had progressive PSMA-positive metastatic castration-resistant prostate cancer; an Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2; and had previously received of at least one androgen receptor pathway inhibitor and one or two taxane-containing regimens. Patients were randomly assigned (2:1) to receive either [177Lu]Lu-PSMA-617 plus protocol-permitted standard of care ([177Lu]Lu-PSMA-617 group) or standard of care alone (control group) using permuted blocks. Randomisation was stratified by baseline lactate dehydrogenase concentration, liver metastases, ECOG performance status, and androgen receptor pathway inhibitor inclusion in standard of care. Patients in the [177Lu]Lu-PSMA-617 group received intravenous infusions of 7·4 gigabecquerel (GBq; 200 millicurie [mCi]) [177Lu]Lu-PSMA-617 every 6 weeks for four cycles plus two optional additional cycles. Standard of care included approved hormonal treatments, bisphosphonates, and radiotherapy. The alternate primary endpoints were radiographic progression-free survival and overall survival, which have been reported. Here we report the key secondary endpoint of time to first symptomatic skeletal event, and other secondary endpoints of HRQOL assessed with the Functional Assessment of Cancer Therapy-Prostate (FACT-P) and EQ-5D-5L, and pain assessed with the Brief Pain Inventory-Short Form (BPI-SF). Patient-reported outcomes and symptomatic skeletal events were analysed in all patients who were randomly assigned after implementation of measures designed to reduce the dropout rate in the control group (on or after March 5, 2019), and safety was analysed according to treatment received in all patients who received at least one dose of treatment. This trial is registered with ClinicalTrials.gov, NCT03511664, and is active but not recruiting. FINDINGS Between June 4, 2018, and Oct 23, 2019, 831 patients were enrolled, of whom 581 were randomly assigned to the [177Lu]Lu-PSMA-617 group (n=385) or control group (n=196) on or after March 5, 2019, and were included in analyses of HRQOL, pain, and time to first symptomatic skeletal event. The median age of patients was 71 years (IQR 65-75) in the [177Lu]Lu-PSMA-617 group and 72·0 years (66-76) in the control group. Median time to first symptomatic skeletal event or death was 11·5 months (95% CI 10·3-13·2) in the [177Lu]Lu-PSMA-617 group and 6·8 months (5·2-8·5) in the control group (hazard ratio [HR] 0·50, 95% CI 0·40-0·62). Time to worsening was delayed in the [177Lu]Lu-PSMA-617 group versus the control group for FACT-P score (HR 0·54, 0·45-0·66) and subdomains, BPI-SF pain intensity score (0·52, 0·42-0·63), and EQ-5D-5L utility score (0·65, 0·54-0·78). Grade 3 or 4 haematological adverse events included decreased haemoglobin (80 [15%] of 529 assessable patients who received [177Lu]Lu-PSMA-617 plus standard of care vs 13 [6%] of 205 who received standard of care only), lymphocyte concentrations (269 [51%] vs 39 [19%]), and platelet counts (49 [9%] vs five [2%]). Treatment-related adverse events leading to death occurred in five (1%) patients who received [177Lu]Lu-PSMA-617 plus standard of care (pancytopenia [n=2], bone marrow failure [n=1], subdural haematoma [n=1], and intracranial haemorrhage [n=1]) and no patients who received standard of care only. INTERPRETATION [177Lu]Lu-PSMA-617 plus standard of care delayed time to worsening in HRQOL and time to skeletal events compared with standard of care alone. These findings support the use of [177Lu]Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer who received previous androgen receptor pathway inhibitor and taxane treatment. FUNDING Advanced Accelerator Applications (Novartis).
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Affiliation(s)
- Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France.
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium, University Hospital Essen, Essen, Germany
| | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Munster, Munster, Germany
| | - Kim N Chi
- Medical Oncology Department, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Oliver Sartor
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Scott T Tagawa
- Department of Urology, Hematology, and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Ayse T Kendi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jeremie Calais
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
| | - James Nagarajah
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Xiao X Wei
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Vadim S Koshkin
- Department of Medicine, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | - Brian Chang
- Radiation Oncology Associates, Parkview Hospital, Fort Wayne, IN, USA
| | - Ray Ghouse
- Advanced Accelerator Applications (Novartis), Geneva, Switzerland
| | | | | | - Johann de Bono
- The Institute of Cancer Research and Royal Marsden Hospital, London, UK
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Zahed H, Beauregard JM, Abikhzer G, Rush C, Probst S. Differential Detection of Hepatic Metastases on 68 Ga-DOTATATE PET/CT and 177 Lu-DOTATATE SPECT/CT. Clin Nucl Med 2023; 48:e12-e15. [PMID: 36240803 DOI: 10.1097/rlu.0000000000004434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT 68 Ga-DOTATATE PET/CT is indicated for selecting patients for peptide receptor radionuclide therapy (PRRT). Although highly sensitive, the detectability of smaller lesions, particularly in the liver, is lower. We present the case of a 58-year-old man with metastatic well-differentiated pancreatic neuroendocrine tumor whose MRI revealed progression of hepatic metastases. 68 Ga-DOTATATE PET/CT performed to determine eligibility for PRRT did not demonstrate DOTATATE-avid disease within the liver. 18 F-FDG PET/CT was also negative at the liver and the patient proceeded to 177 Lu-DOTATATE PRRT, where multi-time point posttherapy planar imaging and SPECT/CT showed intense uptake in the known liver metastases.
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Affiliation(s)
- Hanan Zahed
- From the Department of Nuclear Medicine, Jewish General Hospital, McGill University, Montreal
| | - Jean-Mathieu Beauregard
- Department of Medical Imaging, CHU de Québec-Université Laval; and Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Gad Abikhzer
- From the Department of Nuclear Medicine, Jewish General Hospital, McGill University, Montreal
| | - Christopher Rush
- From the Department of Nuclear Medicine, Jewish General Hospital, McGill University, Montreal
| | - Stephan Probst
- From the Department of Nuclear Medicine, Jewish General Hospital, McGill University, Montreal
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Beauregard JM. Use of imaging-based dosimetry for personalising radiopharmaceutical therapy of cancer. Cancer Imaging 2022; 22:67. [PMID: 36494731 PMCID: PMC9733022 DOI: 10.1186/s40644-022-00505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Theranostics - i.e., the combination of molecular imaging and radiopharmaceutical therapy of cancer targeting a common biological feature - is a rapidly expanding field owing the recent successes of novel radiopharmaceutical therapies, such as 177Lu-based prostate-specific membrane antigen radioligand therapy of prostate cancer and peptide receptor radionuclide therapy of neuroendocrine tumours. Despite the ongoing technical developments in imaging-based dosimetry, the existence of tumour absorbed dose-efficacy and organ absorbed dose-toxicity relationships, as well as the high interpatient variability in absorbed doses per unit activity, radiopharmaceutical therapies are still mostly administered in a fixed-activity, one-size-fits-all fashion. This is at odds with the principles of radiation oncology, where the absorbed doses to tissues are prescribed and their delivery is carefully planned and controlled for each individual patient to maximise the clinical benefits. There is a growing body of clinical evidence that dosimetry-based radiopharmaceutical therapy allows to safely optimise tumour irradiation, which translates into improved clinical outcomes. In this narrative review, we will present the reported prospective clinical experience to date on the use of imaging-based dosimetry to personalise radiopharmaceutical therapies.
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Affiliation(s)
- Jean-Mathieu Beauregard
- grid.411081.d0000 0000 9471 1794Department of Medical Imaging, and Research Center (Oncology Axis), CHU de Québec – Université Laval, 11 côte du Palais, Quebec City, G1R 2J6 Canada ,grid.23856.3a0000 0004 1936 8390Department of Radiology and Nuclear Medicine, and Cancer Research Center, Université Laval, Quebec City, Canada
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Desy A, Bouvet GF, Lafrenière N, Zamanian A, Després P, Beauregard JM. Impact of the dead-time correction method on quantitative 177Lu-SPECT (QSPECT) and dosimetry during radiopharmaceutical therapy. EJNMMI Phys 2022; 9:54. [PMID: 35976503 PMCID: PMC9385894 DOI: 10.1186/s40658-022-00484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dead-time correction is required for accurate quantitative SPECT-based dosimetry in the context of personalised 177Lu radiopharmaceutical therapy. We aimed to evaluate the impact of applying dead-time correction on the reconstructed SPECT image versus on the acquisition projections before reconstruction. METHODS Data from 16 SPECT/CT acquisitions of a decaying 177Lu-filled phantom (up to 20.75 GBq) and dual-timepoint SPECT/CT in 14 patients treated with personalised 177Lu peptide receptor radionuclide therapy were analysed. Dead time was determined based on the acquisition wide-spectrum count rate for each projection and averaged for the entire acquisition. Three dead-time correction methods (DTCMs) were used: the per-projection correction, where each projection was individually corrected before reconstruction (DTCM1, the standard of reference), and two per-volume methods using the average dead-time correction factor of the acquisition applied to all projections before reconstruction (DTCM2) or to the SPECT image after reconstruction (DTCM3). Relative differences in quantification were assessed for various volumes of interest (VOIs) on the phantom and patient SPECT images. In patients, the resulting dosimetry estimates for tissues of interest were also compared between DTCMs. RESULTS Both per-volume DTCMs (DTCM2 and DTCM3) were found to be equivalent, with VOI count differences not exceeding 0.8%. When comparing the per-volume post-reconstruction DTCM3 versus the per-projection pre-reconstruction DTCM1, differences in VOI counts and absorbed dose estimates did not exceed 2%, with very few exceptions. The largest absorbed dose deviation was observed for a kidney at 3.5%. CONCLUSION While per-projection dead-time correction appears ideal for QSPECT, post-reconstruction correction is an acceptable alternative that is more practical to implement in the clinics, and that results in minimal deviations in quantitative accuracy and dosimetry estimates, as compared to the per-projection correction.
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Affiliation(s)
- Alessandro Desy
- Department of Medical Imaging, and Research Centre (Oncology Axis), CHU de Québec - Université Laval, 11 Côte du Palais, QC, G1R 2J6, Quebec City, Canada.,Department of Radiology and Nuclear Medicine, and Cancer Research Centre, Université Laval, Quebec City, Canada
| | - Guillaume F Bouvet
- Department of Medical Imaging, and Research Centre (Oncology Axis), CHU de Québec - Université Laval, 11 Côte du Palais, QC, G1R 2J6, Quebec City, Canada.,Department of Radiology and Nuclear Medicine, and Cancer Research Centre, Université Laval, Quebec City, Canada
| | - Nancy Lafrenière
- Department of Medical Imaging, and Research Centre (Oncology Axis), CHU de Québec - Université Laval, 11 Côte du Palais, QC, G1R 2J6, Quebec City, Canada
| | - Atefeh Zamanian
- Department of Medical Imaging, and Research Centre (Oncology Axis), CHU de Québec - Université Laval, 11 Côte du Palais, QC, G1R 2J6, Quebec City, Canada.,Department of Radiology and Nuclear Medicine, and Cancer Research Centre, Université Laval, Quebec City, Canada
| | - Philippe Després
- Department of Radiation Oncology, and Research Centre (Oncology Axis), CHU de Québec - Université Laval, Quebec City, Canada.,Department of Physics, Physical Engineering and Optics, and Cancer Research Centre, Université Laval, Quebec City, Canada
| | - Jean-Mathieu Beauregard
- Department of Medical Imaging, and Research Centre (Oncology Axis), CHU de Québec - Université Laval, 11 Côte du Palais, QC, G1R 2J6, Quebec City, Canada. .,Department of Radiology and Nuclear Medicine, and Cancer Research Centre, Université Laval, Quebec City, Canada.
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Laforce RJ, Dallaire-Théroux C, Racine AM, Dent G, Salinas-Valenzuela C, Poulin E, Cayer AM, Bédard-Tremblay D, Rouleau-Bonenfant T, St-Onge F, Schraen-Maschke S, Beauregard JM, Sergeant N, Puymirat J. Tau positron emission tomography, cerebrospinal fluid and plasma biomarkers of neurodegeneration, and neurocognitive testing: an exploratory study of participants with myotonic dystrophy type 1. J Neurol 2022; 269:3579-3587. [PMID: 35103843 PMCID: PMC9217820 DOI: 10.1007/s00415-022-10970-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate Tau pathology using multimodal biomarkers of neurodegeneration and neurocognition in participants with myotonic dystrophy type 1 (DM1). METHODS We recruited twelve participants with DM1 and, for comparison, two participants with Alzheimer's Disease (AD). Participants underwent cognitive screening and social cognition testing using the Dépistage Cognitif de Québec (DCQ), among other tests. Biomarkers included Tau PET with [18F]-AV-1451, CSF (Aβ, Tau, phospho-Tau), and plasma (Aβ, Tau, Nf-L, GFAP) studies. RESULTS Of the twelve DM1 participants, seven completed the full protocol (Neurocognition 11/12; PET 7/12, CSF 9/12, plasma 12/12). Three DM1 participants were cognitively impaired (CI). On average, CI DM1 participants had lower scores on the DCQ compared to cognitively unimpaired (CU) DM1 participants (75.5/100 vs. 91.4/100) and were older (54 vs. 44 years old) but did not differ in years of education (11.3 vs. 11.1). The majority (6/7) of DM1 participants had no appreciable PET signal. Only one of the CI participants presented with elevated Tau PET SUVR in bilateral medial temporal lobes. This participant was the eldest and most cognitively impaired, and had the lowest CSF Aβ 1-42 and the highest CSF Tau levels, all suggestive of co-existing AD. CSF Tau and phospho-Tau levels were higher in the 3 CI compared to CU DM1 participants, but with a mean value lower than that typically observed in AD. Nf-L and GFAP were elevated in most DM1 participants (9/11 and 8/11, respectively). Finally, CSF phospho-Tau was significantly correlated with plasma Nf-L concentrations. CONCLUSIONS AND RELEVANCE We observed heterogenous cognitive and biomarker profiles in individuals with DM1. While some participants presented with abnormal PET and/or CSF Tau, these patterns were highly variable and only present in a small subset. Although DM1 may indeed represent a non-AD Tauopathy, the Tau-PET tracer used in this study was unable to detect an in vivo Tau DM1 signature in this small cohort. Interestingly, most DM1 participants presented with elevated plasma Nf-L and GFAP levels, suggestive of other, possibly related, central brain alterations which motivate further research. This pioneering study provides novel insights towards the potential relationship between biomarkers and neurocognitive deficits commonly seen in DM1.
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Affiliation(s)
- Robert Jr Laforce
- Clinique Interdisciplinaire de Mémoire, CHU de Québec, Québec, QC, Canada.
| | | | | | | | | | - Elizabeth Poulin
- Clinique Interdisciplinaire de Mémoire, CHU de Québec, Québec, QC, Canada
| | - Anne-Marie Cayer
- Clinique Interdisciplinaire de Mémoire, CHU de Québec, Québec, QC, Canada
| | | | | | - Frédéric St-Onge
- Clinique Interdisciplinaire de Mémoire, CHU de Québec, Québec, QC, Canada
| | - Susanna Schraen-Maschke
- Université de Lille, Inserm UMRS1172, CHU Lille, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | | | - Nicolas Sergeant
- Université de Lille, Inserm UMRS1172, CHU Lille, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Jack Puymirat
- Clinique Interdisciplinaire de Mémoire, CHU de Québec, Québec, QC, Canada
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9
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Chi KN, Saad F, Parulekar WR, Emmenegger U, Hotte SJ, Pouliot F, Bauman G, Zukotynski KA, Peacock S, Wyatt AW, Beauregard JM, Lee J, Uribe C, Dellar C, Ding K, Benard F. CCTG PR21: A randomized phase II study of [ 177lu]lu-PSMA-617 verus docetaxel in patients with metastatic castration-resistant prostate cancer and PSMA-positive disease (NCT04663997). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS5110 Background: [177Lu]Lu-PSMA-617 improves outcome in men with metastatic, PSMA positive CRPC post androgen pathway inhibitor therapy and taxane chemotherapy compared to standard care (excluding chemotherapy, immunotherapy, radium-223 and investigational drugs; Sartor et al, NEJM 2021). The relative efficacy, adverse event experience and impact on QOL of [177Lu]Lu-PSMA-617 compared to docetaxel chemotherapy in this patient population is unknown. We hypothesize that [177Lu]Lu-PSMA-617 will improve radiographic PFS (rPFS) compared to docetaxel chemotherapy with a favourable safety and tolerability profile. Methods: CCTG PR21 is a Canadian Cancer Trials Group randomized phase II trial with a primary objective to compare rPFS between [177Lu]Lu-PSMA-617 7.4 GBq (+/- 10%) IV q 6 weekly (maximum 6 cycles) versus docetaxel 75 mg/m2 q 3 weekly (maximum 12 cycles). Secondary objectives are to compare the two arms with respect to: 6-month PFS rate (PCWG3 and RECIST 1.1), second rPFS after crossover to the alternate therapy, time to commencement of 3rd line systemic therapy, OS, PSA decline from baseline, clinical benefit rate and adverse events. Tertiary objectives include evaluation of QOL (FACT-P and EQ5D-5L), cost effectiveness, ctDNA and radiographic based prognostic and predictive biomarkers, dosimetry based approach to measurement of [177Lu]Lu-PSMA-617 activity and creation of tissue and image biobanks. Key eligibility criteria include: mCRPC with PSMA positive disease using 18F or 68Ga radionuclide label, progression on ADT + ARPI therapy (using PSA, RECIST 1.1 or PCWG3 criteria) and adequate organ function. Statistical Design: Patients are allocated in 1:1 ratio to [177Lu]Lu-PSMA-617 or docetaxel balanced for stratification factors of ECOG PS, LDH, visceral metastases, previous docetaxel in the castration sensitive setting > 1 year prior to enrollment as well as centre. Assuming a 6-month median rPFS for the control group, the detection of a hazard ratio (HR) of 0.67 with 80% power using a 1-sided 5% level test will require accrual of 200 participants in 24 months with 12-month follow-up to trigger the primary analysis. Conduct to Date: Study activation Dec 17 2020. Enrollment as of January 31 2022: 25. The DSMC last reviewed and recommended continuation of the trial in December 2021. Clinical trial information: NCT04663997.
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Affiliation(s)
- Kim N. Chi
- BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Fred Saad
- University of Montréal Health Center, Montréal, QC, Canada
| | | | | | | | - Frederic Pouliot
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Québec City, QC, Canada
| | - Glenn Bauman
- Western University, London Regional Cancer Program, London, ON, Canada
| | | | | | - Alexander William Wyatt
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Justin Lee
- Lions Gate Hospital, Vancouver, BC, Canada
| | - Carlos Uribe
- BCCA - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Conor Dellar
- Canadian Cancer Trials Group, Kingston, ON, Canada
| | - Keyue Ding
- Canadian Cancer Trials Group, Kingston, ON, Canada
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10
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Pouliot F, Beauregard JM, Saad F, Trudel D, Richard PO, Turcotte É, Rousseau É, Probst S, Kassouf W, Anidjar M, Camirand Lemyre F, Bouvet GF, Neveu B, Tétu A, Guérin B. The Triple-Tracer strategy against Metastatic PrOstate cancer (3TMPO) study protocol. BJU Int 2021; 130:314-322. [PMID: 34674367 PMCID: PMC9546087 DOI: 10.1111/bju.15621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the prevalence of intra-patient inter-metastatic heterogeneity based on positron emission tomography (PET)/computed tomography (CT) in patients with metastatic castration-resistant prostate cancer (mCRPC) and to determine the prevalence of neuroendocrine disease in these patients and their eligibility for radioligand therapies (RLTs). PATIENTS AND METHODS This multicentre observational prospective clinical study will include 100 patients with mCRPC from five Canadian academic centres. Patients with radiological or biochemical progression and harbouring at least three metastases by conventional imaging will be accrued. Intra-patient inter-metastatic heterogeneity will be determined with triple-tracer imaging using fluorine-18 fluorodeoxyglucose (18 F-FDG), gallium-68-(68 Ga)-prostate-specific membrane antigen (PSMA)-617 and 68 Ga-DOTATATE, which are a glucose analogue, a PSMA receptor ligand and a somatostatin receptor ligand, respectively. The 68 Ga-PSMA-617 and 18 F-FDG PET/CT scans will be performed first. If at least one PSMA-negative/FDG-positive lesion is observed, an additional PET/CT scan with 68 Ga-DOTATATE will be performed. The tracer uptake of individual lesions will be assessed for each PET tracer and patients with lesions presenting discordant uptake profiles will be considered as having inter-metastatic heterogeneous disease and may be offered a biopsy. EXPECTED RESULTS The proposed triple-tracer approach will allow whole-body mCRPC characterisation, investigating the inter-metastatic heterogeneity in order to better understand the phenotypic plasticity of prostate cancer, including the neuroendocrine transdifferentiation that occurs during mCRPC progression. Based on 68 Ga-PSMA-617 or 68 Ga-DOTATATE PET positivity, the potential eligibility of patients for PSMA and DOTATATE-based RLT will be assessed. Non-invasive whole-body determination of mCRPC heterogeneity and transdifferentiation is highly innovative and might establish the basis for new therapeutic strategies. Comparison of molecular imaging findings with biopsies will also link metastasis biology to radiomic features. CONCLUSION This study will add novel, biologically relevant dimensions to molecular imaging: the non-invasive detection of inter-metastatic heterogeneity and transdifferentiation to neuroendocrine prostate cancer by using a multi-tracer PET/CT strategy to further personalise the care of patients with mCRPC.
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Affiliation(s)
- Frédéric Pouliot
- Oncology Axis, (CHU) de Québec - Université Laval (CHUQc-UL) Research Centre, Quebec City, QC, Canada.,Urology Division, Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Jean-Mathieu Beauregard
- Oncology Axis, (CHU) de Québec - Université Laval (CHUQc-UL) Research Centre, Quebec City, QC, Canada.,Department of Radiology and Nuclear Medicine, Cancer Research Centre, Université Laval, Quebec City, QC, Canada.,Department of Medical Imaging, CHUQc-UL, Quebec City, QC, Canada
| | - Fred Saad
- CHU de Montréal, Montréal, QC, Canada
| | - Dominique Trudel
- Institut du Cancer de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Pathology and Cellular Biology, Université de Montréal, Montréal, QC, Canada
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Éric Turcotte
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Sherbrooke Molecular Imaging Centre (CIMS), CRCHUS, Sherbrooke, QC, Canada
| | - Étienne Rousseau
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Sherbrooke Molecular Imaging Centre (CIMS), CRCHUS, Sherbrooke, QC, Canada
| | - Stephan Probst
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Wassim Kassouf
- Division of Urology, Department of Surgery, McGill University Health Center, Montréal, QC, Canada
| | - Maurice Anidjar
- Department of Urology, McGill University Health Centre, Jewish General Hospital, Montréal, QC, Canada
| | - Félix Camirand Lemyre
- Health, Populations, Organization, Practices Axis, CRCHUS, Sherbrooke, QC, Canada.,Department of Mathematics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Guillaume F Bouvet
- Oncology Axis, (CHU) de Québec - Université Laval (CHUQc-UL) Research Centre, Quebec City, QC, Canada
| | - Bertrand Neveu
- Oncology Axis, (CHU) de Québec - Université Laval (CHUQc-UL) Research Centre, Quebec City, QC, Canada
| | - Amélie Tétu
- Unité de Recherche Clinique et Épidémiologique (URCE), CRCHUS, Sherbrooke, QC, Canada
| | - Brigitte Guérin
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Sherbrooke Molecular Imaging Centre (CIMS), CRCHUS, Sherbrooke, QC, Canada
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11
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Brosch-Lenz J, Yousefirizi F, Zukotynski K, Beauregard JM, Gaudet V, Saboury B, Rahmim A, Uribe C. Role of Artificial Intelligence in Theranostics:: Toward Routine Personalized Radiopharmaceutical Therapies. PET Clin 2021; 16:627-641. [PMID: 34537133 DOI: 10.1016/j.cpet.2021.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We highlight emerging uses of artificial intelligence (AI) in the field of theranostics, focusing on its significant potential to enable routine and reliable personalization of radiopharmaceutical therapies (RPTs). Personalized RPTs require patient-specific dosimetry calculations accompanying therapy. Additionally we discuss the potential to exploit biological information from diagnostic and therapeutic molecular images to derive biomarkers for absorbed dose and outcome prediction; toward personalization of therapies. We try to motivate the nuclear medicine community to expand and align efforts into making routine and reliable personalization of RPTs a reality.
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Affiliation(s)
- Julia Brosch-Lenz
- Department of Integrative Oncology, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Fereshteh Yousefirizi
- Department of Integrative Oncology, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Katherine Zukotynski
- Department of Medicine and Radiology, McMaster University, 1200 Main Street West, Hamilton, Ontario L9G 4X5, Canada
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine, Cancer Research Centre, Université Laval, 2325 Rue de l'Université, Québec City, Quebec G1V 0A6, Canada; Department of Medical Imaging, Research Center (Oncology Axis), CHU de Québec - Université Laval, 2325 Rue de l'Université, Québec City, Quebec G1V 0A6, Canada
| | - Vincent Gaudet
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Computer Science and Electrical Engineering, University of Maryland Baltimore County, Baltimore, MD, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada; Department of Radiology, University of British Columbia, 11th Floor, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada; Department of Physics, University of British Columbia, 325 - 6224 Agricultural Road, Vancouver, British Columbia V6T 1Z1, Canada
| | - Carlos Uribe
- Department of Radiology, University of British Columbia, 11th Floor, 2775 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada; Department of Functional Imaging, BC Cancer, 675 West 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada.
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12
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Bergeron D, Beauregard JM, Soucy JP, Verret L, Poulin S, Matias-Guiu JA, Cabrera-Martín MN, Bouchard RW, Laforce R. Posterior Cingulate Cortex Hypometabolism in Non-Amnestic Variants of Alzheimer's Disease. J Alzheimers Dis 2021; 77:1569-1577. [PMID: 32925054 DOI: 10.3233/jad-200567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypometabolism of the posterior cingulate cortex (PCC) is an important diagnostic feature of late-onset, amnestic Alzheimer's disease (AD) measured with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). However, it is unclear whether PCC hypometabolism has diagnostic value in young-onset, non-amnestic variants of AD, which exhibit less pathology in the hippocampus and default mode network. OBJECTIVE Evaluate the prevalence and diagnostic value of PCC hypometabolism in non-amnestic variants of AD. METHODS We retrospectively identified 60 patients with young-onset, atypical dementia who have undergone a detailed clinical evaluation, FDG-PET, and an amyloid biomarker (amyloid-PET or cerebrospinal fluid analysis). We quantitatively analyzed regional hypometabolism in 70 regions of interest (ROI) using the MIMneuro® software. RESULTS Based on a cut-off of z-score < -1.5 for significant PCC hypometabolism, the prevalence of PCC hypometabolism in non-amnestic variants of AD was 65% compared to 28% in clinical variants of frontotemporal dementia (FTD). The ROI with the maximal hypometabolism was the dominant middle temporal gyrus in the language variant of AD (mean z score -2.28), middle occipital gyrus in PCA (-3.24), middle temporal gyrus in frontal AD (-2.70), and angular gyrus in corticobasal syndrome due to AD (-2.31). The PCC was not among the 10 most discriminant regions between non-amnestic variants of AD versus clinical variants of FTD. CONCLUSION We conclude that PCC hypometabolism is not a discriminant feature to distinguish non-amnestic variants of AD from clinical variants of FTD-and should be interpreted with caution in patients with young-onset, non-amnestic dementia.
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Affiliation(s)
- David Bergeron
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | | | - Jean-Paul Soucy
- Department of Nuclear Medicine, Montreal Neurological Institute (MNI), Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
| | - Jordi A Matias-Guiu
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - María Nieves Cabrera-Martín
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Rémi W Bouchard
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME) du CHU de Québec, Québec, Canada
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13
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Zhang H, Koumna S, Pouliot F, Beauregard JM, Kolinsky M. PSMA Theranostics: Current Landscape and Future Outlook. Cancers (Basel) 2021; 13:4023. [PMID: 34439177 PMCID: PMC8391520 DOI: 10.3390/cancers13164023] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Prostate-specific membrane antigen (PSMA) is a promising novel molecular target for imaging diagnostics and therapeutics (theranostics). There has been a growing body of evidence supporting PSMA theranostics approaches in optimizing the management of prostate cancer and potentially altering its natural history. METHODS We utilized PubMed and Google Scholar for published studies, and clinicaltrials.gov for planned, ongoing, and completed clinical trials in PSMA theranostics as of June 2021. We presented evolving evidence for various PSMA-targeted radiopharmaceutical agents in the treatment paradigm for prostate cancer, as well as combination treatment strategies with other targeted therapy and immunotherapy. We highlighted the emerging evidence of PSMA and fluorodeoxyglucose (FDG) PET/CT as a predictive biomarker for PSMA radioligand therapy. We identified seven ongoing clinical trials in oligometastatic-directed therapy using PSMA PET imaging. We also presented a schematic overview of 17 key PSMA theranostic clinical trials throughout the various stages of prostate cancer. CONCLUSIONS In this review, we presented the contemporary and future landscape of theranostic applications in prostate cancer with a focus on PSMA ligands. As PSMA theranostics will soon become the standard of care for the management of prostate cancer, we underscore the importance of integrating nuclear medicine physicians into the multidisciplinary team.
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Affiliation(s)
- Hanbo Zhang
- Department of Medical Oncology and Hematology, University of Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Stella Koumna
- Department of Diagnostic Imaging, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada;
| | - Frédéric Pouliot
- Department of Surgery, Université Laval, Québec City, QC G1R 3S1, Canada;
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine, Université Laval, Québec City, QC G1R 3S1, Canada;
| | - Michael Kolinsky
- Department of Medical Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
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14
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Otis-Chapados S, Goulet CR, Dubois G, Lavallée É, Dujardin T, Fradet Y, Lacombe L, Lodde M, Tiguert R, Toren P, Fradet V, Beauregard JM, Buteau FA, Pouliot F. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is accurate for high-grade prostate cancer bone staging when compared to bone scintigraphy. Can Urol Assoc J 2021; 15:301-307. [PMID: 33750523 DOI: 10.5489/cuaj.7107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In this study, we compared 18F-FDG-postron emission tomography/computed tomography (PET/CT) and bone scintigraphy accuracies for the detection of bone metastases for primary staging in high-grade prostate cancer (PCa) patients to determine if 18F-FDG-PET/CT could be used alone as a staging modality. METHODS Men with localized high-grade PCa (n=256, Gleason 8-10, International Society of Urological Pathology [ISUP] grades 4 or 5) were imaged with bone scintigraphy and 18F-FDGPET/CT. We compared on a per-patient basis the accuracy of the two imaging modalities, taking intermodality agreement as the standard of truth (SOT). RESULTS 18F-FDG-PET/CT detected at least one bone metastasis in 33 patients compared to only 26 with bone scan. Of the seven false-negative bone scintigraphies, four (57.1%) were solitary metastases (monometastatic), three (42.9%) were oligometastatic (2-4 lesions), and none were plurimetastatic (>4 lesions). Compared to SOT, 18F-FDG-PET/CT showed higher sensitivity and accuracy than bone scintigraphy (100% vs. 78.8%, and 98.7% vs. 98.2%) for the detection of skeletal lesions. CONCLUSIONS 18F-FDG-PET/CT appears similar or better than conventional bone scans to assess for bone metastases in patients newly diagnosed with high-grade PCa. Since intraprostatic FDG-uptake is also a biomarker of failure to radical prostatectomy and that FDG-PET/CT has been shown to be accurate in detecting PCa lymph node metastasis, FDG-PET/CT has the potential to be used as the sole preoperative staging modality in high-grade PCa.
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Affiliation(s)
- Samuel Otis-Chapados
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Cassandra Ringuette Goulet
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Gabriel Dubois
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | | | - Thierry Dujardin
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Yves Fradet
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Louis Lacombe
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Michele Lodde
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Rabi Tiguert
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Paul Toren
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Vincent Fradet
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Quebec, QC, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Quebec, QC, Canada
| | - Frédéric Pouliot
- Oncology Division, CHU de Québec Research Center, Quebec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada
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15
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Clarke MTM, St-Onge F, Beauregard JM, Bocchetta M, Todd E, Cash DM, Rohrer JD, Laforce R. Early anterior cingulate involvement is seen in presymptomatic MAPT P301L mutation carriers. Alzheimers Res Ther 2021; 13:42. [PMID: 33568215 PMCID: PMC7876816 DOI: 10.1186/s13195-021-00777-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022]
Abstract
Background PET imaging of glucose metabolism has revealed presymptomatic abnormalities in genetic FTD but has not been explored in MAPT P301L mutation carriers. This study aimed to explore the patterns of presymptomatic hypometabolism and atrophy in MAPT P301L mutation carriers. Methods Eighteen asymptomatic members from five families with a P301L MAPT mutation were recruited to the study, six mutation carriers, and twelve mutation-negative controls. All participants underwent standard behavioural and cognitive assessment as well as [18F]FDG-PET and 3D T1-weighted MRI brain scans. Regional standardised uptake value ratios (SUVR) for the PET scan and volumes calculated from an automated segmentation for the MRI were obtained and compared between the mutation carrier and control groups. Results The mean (standard deviation) estimated years from symptom onset was 12.5 (3.6) in the mutation carrier group with a range of 7 to 18 years. No differences in cognition were seen between the groups, and all mutation carriers had a global CDR plus NACC FTLD of 0. Significant reduction in [18F] FDG uptake in the anterior cingulate was seen in mutation carriers (mean 1.25 [standard deviation 0.07]) compared to controls (1.36 [0.09]). A similar significant reduction was also seen in grey matter volume in the anterior cingulate in mutation carriers (0.60% [0.06%]) compared to controls (0.68% [0.08%]). No other group differences were seen in other regions. Conclusions Anterior cingulate hypometabolism and atrophy are both apparent presymptomatically in a cohort of P301L MAPT mutation carriers. Such a specific marker may prove to be helpful in stratification of presymptomatic mutation carriers in future trials. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00777-9.
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Affiliation(s)
- Mica T M Clarke
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.
| | - Frédéric St-Onge
- Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada.,Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques, CHU de Québec-Université Laval, Québec, QC, Canada.,Faculté de Médecine, Département de médecine, Université Laval, Québec, QC, Canada
| | | | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Emily Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Robert Laforce
- Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada.,Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques, CHU de Québec-Université Laval, Québec, QC, Canada.,Faculté de Médecine, Département de médecine, Université Laval, Québec, QC, Canada.,CHU de Québec, Québec, QC, Canada
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16
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Huot Daneault A, Desaulniers M, Beauregard JM, Beaulieu A, Arsenault F, April G, Turcotte É, Buteau FA. Highly Symptomatic Progressing Cardiac Paraganglioma With Intracardiac Extension Treated With 177Lu-DOTATATE: A Case Report. Front Endocrinol (Lausanne) 2021; 12:705271. [PMID: 34367072 PMCID: PMC8339957 DOI: 10.3389/fendo.2021.705271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Primary cardiac paragangliomas are rare tumors. Metastatic disease is even rarer. Surgical management is technically challenging, and sometimes even impossible. Available therapeutic modalities for metastatic disease include external beam radiation therapy as well as systemic treatments, namely 131I-MIBG and more recently, peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE. To our knowledge, this is the first case of progressive unresectable cardiac paraganglioma with intracardiac extension treated with dosimetry based personalized PRRT to be reported. This case is of particular interest since it documents for the first time the efficacy, and especially the safety of the 177Lu-DOTATATE PRRT in this precarious context for which therapeutic options are limited. CASE PRESENTATION A 47-year-old man with no medical history consulted for rapidly decreasing exercise tolerance. The investigation demonstrated an unresectable progressing metastatic cardiac paraganglioma with intracardiac extension. The patient was treated with personalized 177Lu-DOTATATE PRRT and showed complete symptomatic and partial anatomical responses, with a progression-free survival of 13 months. CONCLUSIONS PRRT with 177Lu-DOTATATE should be considered for inoperable cardiac paraganglioma. No major hemodynamic complications were experienced. Therapy resulted in safety and substantially improved quality of life.
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Affiliation(s)
- Alexis Huot Daneault
- Département de médecine nucléaire et radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Desaulniers
- Département de médecine nucléaire et radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Mathieu Beauregard
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
| | - Alexis Beaulieu
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
| | - Frédéric Arsenault
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
| | - Geneviève April
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
| | - Éric Turcotte
- Département de médecine nucléaire et radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François-Alexandre Buteau
- Département d’imagerie médicale, Division médecine nucléaire, CHU de Québec, Québec, QC, Canada
- *Correspondence: François-Alexandre Buteau,
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17
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Hou X, Brosch J, Uribe C, Desy A, Böning G, Beauregard JM, Celler A, Rahmim A. Feasibility of Single-Time-Point Dosimetry for Radiopharmaceutical Therapies. J Nucl Med 2020; 62:1006-1011. [PMID: 33127625 DOI: 10.2967/jnumed.120.254656] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/08/2020] [Indexed: 11/16/2022] Open
Abstract
Because of challenges in performing routine personalized dosimetry in radiopharmaceutical therapies, interest in single-time-point (STP) dosimetry, particularly using only a single SPECT scan, is on the rise. Meanwhile, there are questions about the reliability of STP dosimetry, with limited independent validations. In the present work, we analyzed 2 STP dosimetry methods and evaluated dose errors for several radiopharmaceuticals based on effective half-life distributions. Methods: We first challenged the common assumption that radiopharmaceutical effective half-lives across the population are gaussian-distributed (i.e., follow a normal distribution). Then, dose accuracy was estimated using 2 STP dosimetry methods for a wide range of potential post injection (p.i.) scan time points for different radiopharmaceuticals applied to neuroendocrine tumors and prostate cancer. The accuracy and limitations of each of the STP methods were discussed. Results: A lognormal distribution was more appropriate for capturing effective half-life distributions. The STP framework was promising for dosimetry of 177Lu-DOTATATE and for kidney dosimetry of different radiopharmaceuticals (errors < 30%). Meanwhile, for some radiopharmaceuticals, STP accuracy was compromised (e.g., in bone marrow and tumors for 177-labeled prostate-specific membrane antigen [PSMA])). The optimal SPECT scanning time for 177Lu-DOTATATE was approximately 72 h p.i., whereas 48 h p.i. was better for 177Lu-PSMA. Conclusion: Simplified STP dosimetry methods may compromise the accuracy of dose estimates, with some exceptions, such as for 177Lu-DOTATATE and for kidney dosimetry in different radiopharmaceuticals. Simplified personalized dosimetry in the clinic continues to be challenging. On the basis of our results, we make suggestions and recommendations for improved personalized dosimetry using simplified imaging schemes.
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Affiliation(s)
- Xinchi Hou
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada;
| | - Julia Brosch
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Carlos Uribe
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Functional Imaging, BC Cancer, Vancouver, British Columbia, Canada
| | - Alessandro Desy
- Cancer Research Centre and Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Quebec, Canada.,Department of Medical Imaging and Oncology, Université Laval Research Centre, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; and
| | - Guido Böning
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Jean-Mathieu Beauregard
- Cancer Research Centre and Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Quebec, Canada.,Department of Medical Imaging and Oncology, Université Laval Research Centre, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; and
| | - Anna Celler
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arman Rahmim
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; .,Functional Imaging, BC Cancer, Vancouver, British Columbia, Canada.,Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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18
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Desy A, Bouvet GF, Frezza A, Després P, Beauregard JM. Impact of dead time on quantitative 177Lu-SPECT (QSPECT) and kidney dosimetry during PRRT. EJNMMI Phys 2020; 7:32. [PMID: 32415492 PMCID: PMC7229114 DOI: 10.1186/s40658-020-00303-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dead time may affect the accuracy of quantitative SPECT (QPSECT), and thus of dosimetry. The aim of this study was to quantify the effect of dead time on 177Lu-QSPECT and renal dosimetry following peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumours. METHODS QSPECT/CT was performed on days 1 and 3 during 564 personalized 177Lu-octreotate cycles in 166 patients. The dead-time data for each scanning time point was compiled. The impact of not correcting QSPECT for the dead time was assessed for the kidney dosimetry. This was also estimated for empiric PRRT by simulating in our cohort a regime of 7.4 GBq/cycle. RESULTS The probability to observe a larger dead time increased with the injected activity. A dead-time loss greater than 5% affected 14.4% and 5.7% of QSPECT scans performed at days 1 and 3, respectively. This resulted in renal absorbed dose estimates that would have been underestimated by more than 5% in 5.7% of cycles if no dead-time correction was applied, with a maximum underestimation of 22.1%. In the simulated empiric regime, this potential dose underestimation would have been limited to 6.2%. CONCLUSION Dead-time correction improves the accuracy of dosimetry in 177Lu radionuclide therapy and is warranted in personalized PRRT.
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Affiliation(s)
- Alessandro Desy
- Cancer Research Centre and Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Division of Research Centre, CHU de Québec-Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada
| | - Guillaume F Bouvet
- Cancer Research Centre and Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Division of Research Centre, CHU de Québec-Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada
| | - Andrea Frezza
- Cancer Research Centre and Department of Physics, Engineering Physics and Optics, Université Laval, Quebec City, QC, Canada
| | - Philippe Després
- Cancer Research Centre and Department of Physics, Engineering Physics and Optics, Université Laval, Quebec City, QC, Canada.,Department of Radiation Oncology and Oncology Division of Research Centre, CHU de Québec-Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Jean-Mathieu Beauregard
- Cancer Research Centre and Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada. .,Department of Medical Imaging and Oncology Division of Research Centre, CHU de Québec-Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada.
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19
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Pouliot F, Meizou S, Ringuette Goulet C, Hovington H, Lefebvre V, Lavallée E, Bergeron M, Brisson H, Champagne A, Neveu B, Lacombe D, Beauregard JM, Buteau FA, Riopel J. GLUT1 expression in high-risk prostate cancer: Correlation with 18F-FDG-PET/CT and clinical outcome. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
291 Background: Tumour FDG-uptake is of prognostic value in high-risk and metastatic prostate cancer (PCa). The aim of this study is to investigate the underlying glucose metabolism mechanisms of 18F-FDG-uptake on PET/CT imaging in PCa. Methods: Retrospective analysis was conducted for 94 patients diagnosed with a Gleason sum ≥8 at biopsy who underwent 18F-FDG-PET/CT imaging before radical prostatectomy. GLUT1, GLUT12 and HK2 expression were blindly scored after immunohistochemistry on radical prostatectomy specimens by 3 pathologists. 18F-FDG-uptake in primary lesion was measured by a blinded reader using maximum standardized uptake value (SUVmax). Correlations between GLUT1, GLUT12 and HK2 and SUVmax were assessed using Spearman’s rank correlation test. Survival probabilities were based on the Kaplan-Meier method. Results: With a median follow-up of 4.5 years, 56% (n=53) of patients had biochemical recurrence, 7% (n=7) progressed to castration-resistant PCa (CRPC) disease, 13% (n=12) developed metastasis and 6% (n=6) died. Correlation was found between GLUT1 expression and SUVmax level (r=0.2512, p=0.0182). In addition, SUVmax was significantly higher in tumours with high GLUT1 expression (n=17, 5.74±1.67) than tumours with low GLUT1 expression (n=71, 2.68±0.31, P=0.0037). Also, contrary to GLUT12 and HEX2 expression, a significant association was found between GLUT-1 expression levels and SUVmax index (p=0.004), lymph node status (p=0.046), volume of cancer (P=0.013), CRPC-free survival (p=0.02) and metastasis-free survival (p=0.04). Conclusions: GLUT1 expression in PCa tumours correlates with 18F-FDG-uptake and poor prognostic factors. These results suggest that this transporter is involved in the molecular mechanism of 18F-FDG-uptake in high-risk PCa and raise interest in targeting metabolic dependencies of PCa cells as a selective anticancer strategy.
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Affiliation(s)
- Frederic Pouliot
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Cassandra Ringuette Goulet
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Helene Hovington
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Veronique Lefebvre
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Etienne Lavallée
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Michelle Bergeron
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Hervé Brisson
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Audrey Champagne
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Bertrand Neveu
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | - Didier Lacombe
- Cancer Research Center, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
| | | | | | - Julie Riopel
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC, Canada
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20
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Frezza A, Desport C, Uribe C, Zhao W, Celler A, Després P, Beauregard JM. Comprehensive SPECT/CT system characterization and calibration for 177Lu quantitative SPECT (QSPECT) with dead-time correction. EJNMMI Phys 2020; 7:10. [PMID: 32060777 PMCID: PMC7021856 DOI: 10.1186/s40658-020-0275-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background Personalization of 177Lu-based radionuclide therapy requires implementation of dosimetry methods that are both accurate and practical enough for routine clinical use. Quantitative single-photon emission computed tomography/computed tomography (QSPECT/CT) is the preferred scanning modality to achieve this and necessitates characterizing the response of the camera, and calibrating it, over the full range of therapeutic activities and system capacity. Various methods to determine the camera calibration factor (CF) and the deadtime constant (τ) were investigated, with the aim to design a simple and robust protocol for quantitative 177Lu imaging. Methods The SPECT/CT camera was equipped with a medium energy collimator. Multiple phantoms were used to reproduce various attenuation conditions: rod sources in air or water-equivalent media, as well as a Jaszczak phantom with inserts. Planar and tomographic images of a wide range of activities were acquired, with multiple energy windows for scatter correction (double or triple energy window technique) as well as count rate monitoring over a large spectrum of energy. Dead time was modelled using the paralysable model. CF and τ were deduced by curve fitting either separately in two steps (CF determined first using a subset of low-activity acquisitions, then τ determined using the full range of activity) or at once (both CF and τ determined using the full range of activity). Total or segmented activity in the SPECT field of view was computed. Finally, these methods were compared in terms of accuracy to recover the known activity, in particular when planar-derived parameters were applied to the SPECT data. Results The SPECT camera was shown to operate as expected on a finite count rate range (up to ~ 350 kcps over the entire energy spectrum). CF and τ from planar (sources in air) and SPECT segmented Jaszczak data yielded a very good agreement (CF < 1% and τ < 3%). Determining CF and τ from a single curve fit made dead-time-corrected images less prone to overestimating recovered activity. Using triple-energy window scatter correction while acquiring one or more additional energy window(s) to enable wide-spectrum count rate monitoring (i.e. ranging 55–250 or 18–680 keV) yielded the most consistent results across the various geometries. The final, planar-derived calibration parameters for our system were a CF of 9.36 ± 0.01 cps/MBq and a τ of 0.550 ± 0.003 μs. Using the latter, the activity in a Jaszczak phantom could be quantified by QSPECT with an accuracy of 0.02 ± 1.10%. Conclusions Serial planar acquisitions of sources in air using an activity range covering the full operational capacity of the SPECT/CT system, with multiple energy windows for wide-spectrum count rate monitoring, and followed by simultaneous determination of CF and τ using a single equation derived from the paralysable model, constitutes a practical method to enable accurate dead-time-corrected QSPECT imaging in a post-177Lu radionuclide therapy setting.
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Affiliation(s)
- Andrea Frezza
- Cancer Research Center, Université Laval, Quebec City, QC, Canada.,Department of Physics, Engineering Physics and Optics, Université Laval, Quebec City, QC, Canada.,Oncology Division, CHU de Québec - Université Laval Research Center, Quebec City, QC, Canada
| | - Corentin Desport
- Cancer Research Center, Université Laval, Quebec City, QC, Canada.,Department of Physics, Engineering Physics and Optics, Université Laval, Quebec City, QC, Canada.,Oncology Division, CHU de Québec - Université Laval Research Center, Quebec City, QC, Canada
| | - Carlos Uribe
- Functional Imaging Department, BC Cancer, Vancouver, BC, Canada
| | - Wei Zhao
- Medical Imaging Research Group, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Anna Celler
- Medical Imaging Research Group, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Philippe Després
- Cancer Research Center, Université Laval, Quebec City, QC, Canada.,Department of Physics, Engineering Physics and Optics, Université Laval, Quebec City, QC, Canada.,Oncology Division, CHU de Québec - Université Laval Research Center, Quebec City, QC, Canada.,Department of Radiation Oncology, CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Jean-Mathieu Beauregard
- Cancer Research Center, Université Laval, Quebec City, QC, Canada. .,Oncology Division, CHU de Québec - Université Laval Research Center, Quebec City, QC, Canada. .,Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, QC, Canada. .,Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada.
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21
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Meziou S, Ringuette Goulet C, Hovington H, Lefebvre V, Lavallée É, Bergeron M, Brisson H, Champagne A, Neveu B, Lacombe D, Beauregard JM, Buteau FA, Riopel J, Pouliot F. GLUT1 expression in high-risk prostate cancer: correlation with 18F-FDG-PET/CT and clinical outcome. Prostate Cancer Prostatic Dis 2020; 23:441-448. [PMID: 31932660 DOI: 10.1038/s41391-020-0202-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Tumour 18F-FDG-uptake is of prognostic value in high-risk and metastatic prostate cancer (PCa). The aim of this study is to investigate the underlying glucose metabolism mechanisms of 18F-FDG-uptake on PET/CT imaging in PCa. METHODS Retrospective analysis was conducted for 94 patients diagnosed with a Gleason sum ≥8 adenocarcinoma of the prostate at biopsy between July 2011 and July 2014 who underwent 18F-FDG-PET/CT imaging before radical prostatectomy (RP). 18F-FDG-uptake in primary lesion was measured by a blinded reader using maximum standardised uptake value (SUVmax). GLUT1, GLUT12 and HK2 expression were blindly scored after immunohistochemistry on specimens RP by three pathologists. Correlations between GLUT1, GLUT12 and HK2, and SUVmax were assessed using Spearman's rank correlation test. Survival probabilities were based on the Kaplan-Meier method. RESULTS With a median follow-up of 4.5 years, 56% (n = 53) of patients had biochemical recurrence (BCR), 7% (n = 7) progressed to castration-resistant prostate cancer (CRPC) disease, 13% (n = 12) developed metastasis and 6% (n = 6) died. Correlation was found between GLUT1 expression and SUVmax level (r = 0.25, p = 0.02). In addition, SUVmax was significantly higher in tumours with high GLUT1 expression (n = 17, 5.74 ± 1.67) than tumours with low GLUT1 expression (n = 71, 2.68 ± 0.31, p = 0.004). Moreover, a significant association was found between GLUT1 expression levels and SUVmax level (p = 0.005), lymph node status (p = 0.05), volume of cancer (p = 0.01), CRPC disease progression (p = 0.02) and metastasis development (p = 0.04). No significant difference between GLUT12 and HEX2 expression and SUVmax have been found. CONCLUSIONS GLUT1 expression in PCa tumours correlates with 18F-FDG-uptake and poor prognostic factors. These results suggest that this transporter is involved in the molecular mechanism of 18F-FDG-uptake in high-risk PCa and raise interest in targeting metabolic dependencies of PCa cells as a selective anticancer strategy.
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Affiliation(s)
- Salma Meziou
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Pathology, CHU de Québec, Québec, QC, Canada
| | - Cassandra Ringuette Goulet
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Hélène Hovington
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | | | - Étienne Lavallée
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Michelle Bergeron
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Hervé Brisson
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Audrey Champagne
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Bertrand Neveu
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Didier Lacombe
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Jean-Mathieu Beauregard
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Québec, QC, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Québec, QC, Canada
| | - Julie Riopel
- Department of Pathology, CHU de Québec, Québec, QC, Canada
| | - Frédéric Pouliot
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada. .,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.
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22
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Schneider JR, Shatzkes DR, Scharf SC, Tham TM, Kulason KO, Buteau FA, Del Prete M, Chakraborty S, Anderson TA, Asiry S, Beauregard JM, Langer DJ, Costantino PD, Boockvar JA. Neuroradiological and Neuropathological Changes After 177Lu-Octreotate Peptide Receptor Radionuclide Therapy of Refractory Esthesioneuroblastoma. Oper Neurosurg (Hagerstown) 2019; 15:100-109. [PMID: 29554305 DOI: 10.1093/ons/opy028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a malignant neoplasm with an unpredictable behavior. Currently, the widely accepted treatment is inductive chemotherapy, with or without surgery, followed by radiotherapy. Since data on genetics and molecular alterations of ENB are lacking, there is no standard molecularly targeted therapy. However, ENB commonly expresses the somatostatin receptor (SSTR) that is also expressed by neuroendocrine tumors. Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogues, such as 177Lu-octreotate, is an effective treatment for the latter. We present the complex neuroradiological and neuropathological changes associated with 177Lu-octreotate treatment of a patient with a highly treatment-resistant ENB. CLINICAL PRESENTATION A 60-yr-old male presented with an ENB that recurred after chemotherapy, surgery, stereotactic radiosurgery, and immunotherapy. Pathology revealed a Hyams grade 3 ENB and the tumor had metastasized to lymph nodes. Tumor SSTR expression was seen on 68Ga-octreotate positron emission tomography (PET)/computed tomography (CT), suggesting that PRRT may be an option. He received 4 cycles of 177Lu-octreotate over 6 mo, with a partial response of all lesions and symptomatic improvement. Four months after the last PRRT cycle, 2 of the lesions rapidly relapsed and were successfully resected. Three months later, 68Ga-octreotate PET/CT and magnetic resonance imaging indicate no progression of the disease. CONCLUSION We describe imaging changes associated with 177Lu-octreotate PRRT of relapsing ENB. To our knowledge, this is the first report describing neuropathological changes associated with this treatment. PRRT is a promising therapeutic option to improve the disease control, and potentially, the survival of patients with refractory ENB.
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Affiliation(s)
- Julia R Schneider
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Deborah R Shatzkes
- Department of Radiology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Stephen C Scharf
- Department of Nuclear Medicine, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Tristan M Tham
- Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Kay O Kulason
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | | | - Michela Del Prete
- Department of Medical Imaging, CHU de Québec-Université Laval, Quebec City, Canada
| | - Shamik Chakraborty
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Todd A Anderson
- Department of Pathology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Saeed Asiry
- Department of Pathology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | | | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Radiology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Peter D Costantino
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
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Hou X, Zhao W, Beauregard JM, Celler A. Personalized kidney dosimetry in 177Lu-octreotate treatment of neuroendocrine tumours: a comparison of kidney dosimetry estimates based on a whole organ and small volume segmentations. Phys Med Biol 2019; 64:175004. [PMID: 31456584 DOI: 10.1088/1361-6560/ab32a1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Peptide receptor radionuclide therapy (PRRT) with 177Lu- radiolabeled octreotate is an effective treatment method for inoperable neuroendocrine tumours (NETs). There is growing evidence that estimates of the organ-at-risks (OARs) doses are necessary for the optimization of personalized PRRT (P-PRRT). Dosimetry, however, requires a complicated and time-consuming procedure, which hinders its implementation in the clinic. The aim of this study is to develop a practical and automatic technique to simplify personalized dosimetry of kidney, the major OAR in 177Lu P-PRRT. The data from 30 NETs patients undergoing 44 personalized 177Lu-DOTA-TATE therapy cycles were analyzed. To determine the biokinetics of the radiopharmaceutical in the kidneys, for each patient three SPECT/CT scans were acquired, at about 4 h, 24 h and 70 h after injection. The kidneys doses were evaluated using three different approaches: (1) a traditional approach based on whole kidney (WK) segmentation; (2) a small volume (SV) manual approach (M-SV) with observer-defined SV location; and (3) a software based SV-approach that automatically defines SV location (A-SV). Four different methods of automatic SV location selections were investigated. The SV kidney doses estimated using M-SV and A-SV approaches was evaluated and the accuracy of these two approaches were compared to the WK dosimetry. The kidney bio-kinetics, in terms of effective half-lives, obtained from both of the A-SV and M-SV approaches agreed to within 10% with those obtained from the WK segmentation. The average ratios of SV doses to WK doses were mostly about 1.8 ± 0.2 for both A-SV and M-SV approaches. The linear correlation coefficients between SV doses (both A-SV and M-SV) and WK doses were up to 0.9 with p < 0.001. The differences between A-SV and M-SV were minor. By comparing different methods of SV location selections, independently selecting SV in images from each of the acquisitions was proved the most appropriate and accurate approach. An automatic, observer-independent method for selecting the location of the small volume in kidneys was developed. The accuracy of this dose estimation approach has been demonstrated by comparing it with the manual SV dosimetry, as well as the WK dosimetry. The proposed automatic approach can potentially be considered as a practical and simple method for dose estimation in the future clinical studies.
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Affiliation(s)
- Xinchi Hou
- Department of Radiology, University of British Columbia, Vancouver, Canada. The first two authors made equal contribution to this study and would be considered as co-first authors of this paper. Author to whom any correspondence should be addressed. Department of Radiology, University of British Columbia, 828 West 10th Avenue, Rm 366, Vancouver, BC, V5Z1L8, Canada
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Zhao W, Esquinas PL, Frezza A, Hou X, Beauregard JM, Celler A. Accuracy of kidney dosimetry performed using simplified time activity curve modelling methods: a 177Lu-DOTATATE patient study. Phys Med Biol 2019; 64:175006. [PMID: 31287093 DOI: 10.1088/1361-6560/ab3039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
177Lu-DOTATATE therapy has been shown to produce encouraging results in treatment of neuroendocrine tumours (NETs). Unfortunately, since dosimetry for radionuclide therapy is considered to be challenging, typically similar amount of radiopharmaceutical is administered to every patient. There is growing evidence that the efficacy of this therapy can be significantly improved by employing personalized protocols, based on the organ-at-risk dosimetry. The aim of this study is to propose a practical and accurate dosimetry protocol based on the simplified acquisition schedules. Data from fifty-three therapy cycles in thirty-nine NET patients were analyzed. Three SPECT/CT scans, acquired at 4 h (D0), 23 h (D1) and 70 h (D3) after injection, were performed. The kidney volume was determined using CT and the activity was determined from quantitative SPECT using an iterative thresholding method. For each dataset, four methods were used to model the time-activity-curves (TAC): M1-two trapezoid segments (0 to D0 and D0 to D1), followed by monoexponential fit to D1 + D3 data; M2-monoexponential fit to D0 + D1 + D3 data; M3 and M4-monoexponential fit to D0 + D3 and D1 + D3 data, respectively. Additionally, kidney doses obtained from single time point method using a monoexponential curve with the population mean effective half-life, normalized to activities at D0 or D1 or D3 points, were calculated. The accuracy of simplified dosimetry methods was assessed as the percentage difference relative to doses calculated from M1. The major contribution to the absorbed dose estimate comes from the area under the late time portion of the TAC (D1 to infinity). Therefore, information from the late scan (D3) is crucial for the determination of kidney absorbed doses. Single time point method using monoexponential TAC, with the population mean effective half-life normalized to the late data point (48-72 h for kidneys) produces <10% deviation in the absorbed dose estimation, thus is recommended for clinical use.
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Affiliation(s)
- Wei Zhao
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada. Medical Imaging Research Group, Department of Radiology, University of British Columbia, Vancouver, BC, Canada. Author to whom any correspondence should be addressed
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St-Onge F, Karteek P, Beg MF, Beauregard JM, Bocchetta M, Masellis M, Cash DM, Dick KM, van Swieten JC, Borroni B, Galimberti D, Tartaglia C, Rowe JB, Graff C, Tagliavini F, Frisoni GB, Finger E, de Mendonca A, Sorbi S, Warren JD, Rohrer JD, Laforce R. P1-380: EARLY REGIONAL HYPOMETABOLISM IN PRE-SYMPTOMATIC CARRIERS OF MAPT
: A GENFI SUB-STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Frederic St-Onge
- Centre de Recherche du CHU de Québec; Université Laval; Quebec QC Canada
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques; CHU de Québec-Université Laval; Quebec QC Canada
- Faculté de Médecine, Département de Psychiatrie et de Neurosciences; Université Laval; Quebec QC Canada
| | | | | | | | - Martina Bocchetta
- Dementia Research Centre, Queen Square Institute of Neurology; University College London; London United Kingdom
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program; Sunnybrook Research Institute; Toronto ON Canada
- Sunnybrook Research Institute; University of Toronto; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - David M. Cash
- UCL Centre for Medical Image Computing; London United Kingdom
- Dementia Research Centre; UCL Institute of Neurology; London United Kingdom
| | - Katrina M. Dick
- Dementia Research Centre, Institute of Neurology; University College London; London United Kingdom
| | | | | | - Daniela Galimberti
- University of Milan; Fondazione Cà Granda, IRCCS Ospedale Policlinico; Milan Italy
| | - Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases; University of Toronto; Toronto ON Canada
| | | | - Caroline Graff
- Karolinska Institutet; Stockholm Sweden
- Center for Alzheimer Research, Division of Neurogeriatrics; Karolinska Institutet; Huddinge Sweden
| | - Fabrizio Tagliavini
- Division of Neurology V/Neuropathology; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | | | | | | | | | - Jason D. Warren
- Dementia Research Centre, Queen Square Institute of Neurology; University College London; London United Kingdom
| | - Jonathan D. Rohrer
- Dementia Research Centre, Institute of Neurology; University College London; London United Kingdom
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques; CHU de Québec-Université Laval; Quebec QC Canada
- Faculté de Médecine; Université Laval; Quebec QC Canada
- Centre de Recherche du CHU de Québec-Université Laval; Québec QC Canada
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26
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Morris MJ, Durack JC, Alva AS, Vargas HA, Piert M, Pachynski RK, Pouliot F, Beauregard JM, Preston MA, Choudhury AD, Saperstein L, Carroll P, Rowe SP, Pienta KJ, Lin T, Wong V, Nichols M, Jensen JD, Siegel BA. Diagnostic performance of 18F-DCFPyL in the OSPREY Trial: A prospective phase 2/3 multicenter study of 18F-DCFPyL PET/CT imaging in patients (Pts) with known or suspected metastatic prostate cancer (mPC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5012 Background: Accurate detection of prostate cancer is imperative to patient management, yet standard imaging methods perform poorly in accurately detecting mPC. 18F-DCFPyL is a novel PET imaging agent that selectively binds to prostate-specific membrane antigen, a recognized target for prostate cancer. OSPREY was a prospective, multicenter study in pts with either newly diagnosed high-risk prostate cancer (cohort A), or known or suspected mPC (cohort B). Here we focus on Cohort B. Methods: 117 men planned for biopsy of recurrent or mPC received 18F-DCFPyL. Pts underwent image-guided biopsy. Sensitivity, positive predictive value (PPV), and safety of 18F-DCFPyL PET/CT were the key endpoints for Cohort B. 18F-DCFPyL PET/CT scans were evaluated by three independent, blinded central readers; and results were compared to histopathology as the truth standard. Results: The sensitivity and PPV of 18F-DCFPyL PET/CT as compared to histopathology ranged from 92.9-98.6% (lower bound of 95% CI: 84.0-91.6%) and 81.2-87.8%, respectively. Diagnostic performance by anatomic location showed high sensitivity and high PPV in all sites of disease (Table). Only two (1.7%) cohort B pts experienced ≥1 drug-related AE (dysgeusia and generalized rash), both were mild (Grade 1) in severity. Conclusions: 18F-DCFPyL PET/CT was well tolerated and demonstrated high sensitivity and PPV in accurately detecting nodal, bone, and visceral/soft tissue metastases. A positive 18F-DCFPyL PET/CT scan is highly likely to represent pathologically proven distant disease, demonstrating the potential of 18F-DCFPyL as a PET imaging agent to favorably influence treatment planning. Clinical trial information: NCT02981368. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Peter Carroll
- University of California San Francisco, San Francisco, CA
| | - Steven P. Rowe
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth J. Pienta
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tess Lin
- Progenics Pharmaceuticals, Inc., New York, NY
| | - Vivien Wong
- Progenics Pharmaceuticals, Inc., New York, NY
| | | | | | - Barry A. Siegel
- Washington University School of Medicine in St. Louis, St. Louis, MO
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Vigneault E, Carignan D, Pouliot F, Martin AG, Foster W, Lavallée MC, Lacroix F, Aubin S, Després P, Beaulieu L, Beauregard JM. Feasibility of Intraprostatic Prostate Cancer Imaging with FCH-PET/CT for Preoperative Planning of Image-Guided HDR Brachytherapy. Brachytherapy 2019. [DOI: 10.1016/j.brachy.2019.04.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Williams S, Beauregard JM, Roselt P, Moody K, Fisher R, Drummond E, Hicks RJ. A randomized trial comparing fluorocholine-PET/CT with conventional imaging in prostate cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2 Background: We conducted a randomised trial comparing 18Flourocholine-PET/CT (FCH) to Computed Tomography (abdomen and pelvis) plus 99mTc-Whole Body Bone Scan (Conventional Imaging [CIm]) to determine imaging performance in prostate cancer (PC). Methods: This prospective two-arm 1:1 randomised trial enrolled men with newly diagnosed or biochemically recurrent PC to first-line imaging (FLI) with either CIm or FCH. Participants without evidence of metastases proceeded to second-line imaging (SLI) using the alternative imaging strategy. The primary aim was to determine whether FCH was more effective as a FLI approach in changing management. Secondary endpoints included incremental utility of SLI and negative predictive value (NPV) based on progression-free survival (PFS). Australian New Zealand Clinical Trials Registry ACTRN12608000641392. Results: 108 men were enrolled; 44% were for staging of newly-diagnosed PC and median follow-up 43 months. Imaging impacted clinical management in 32.4% of men (95% CI=23.7-42.1%), mostly with FLI (n=30). High-impact management changes occurred in 27.8% (95% CI=16.5-41.6%) of FCH cases compared with 11.1% (95% CI=4.2-22.6%) in the CIm arm (p=0.032). The final management plan was derived using FCH in 98.1% (95% CI = 90.1-100%) of cases and 92.6% (95%CI = 82.1-97.9%) of CIm cases (p=0.242). FLI with FCH showed unequivocally N1 or M1 disease in 22.2% (95% CI = 12-35.6%), and 16.7% (95% CI = 7.9-29.3%; p= 0.531) of CIm cases. The overall NPV for stage TxN0M0 (from all imaging) was 26.3% (95% CI: 13.9 - 41.2%), with no significant difference between arms (p=0.9). For N1M0 cases, the NPV was 14.3% (95% CI: 7.1 - 35.7%). The identification of N1M0 by FCH resulted in a longer time to identification of progressive disease, with a median PFS of 32 months (95% CI=2-68months) compared with 3 months (95% CI=1-16 months) in the CIm N1M0 cohort (p=0.05). Conclusions: FCH-PET/CT identifies more high-clinical-impact lesions than CIm as first-line imaging. All imaging modalities were poor at predicting subsequent progressive disease. Isolated node-positive disease seen with FCH is associated with a longer time to - but similarly high rates of - recurrence, suggesting a lead-time bias. Clinical trial information: ACTRN12608000641392.
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Affiliation(s)
| | | | - Peter Roselt
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate Moody
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Richard Fisher
- Peter MacCallum Cancer Centre, East Melbourne, Australia
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Del Prete M, Buteau FA, Arsenault F, Saighi N, Bouchard LO, Beaulieu A, Beauregard JM. Personalized 177Lu-octreotate peptide receptor radionuclide therapy of neuroendocrine tumours: initial results from the P-PRRT trial. Eur J Nucl Med Mol Imaging 2018; 46:728-742. [PMID: 30506283 DOI: 10.1007/s00259-018-4209-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/30/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Peptide receptor radionuclide therapy (PRRT) is mostly administered using a fixed injected activity (IA) per cycle. This empiric regime results in highly variable absorbed doses to the critical organs and undertreatment of the majority of patients. We conceived a personalized PRRT protocol in which the IA is adjusted to deliver a prescribed absorbed dose to the kidney, with the aim to safely increase tumour irradiation. We herein report on the initial results of our prospective study of personalized PRRT, the P-PRRT Trial (NCT02754297). METHODS PRRT-naïve patients with progressive and/or symptomatic neuroendocrine tumour (NET) were scheduled to receive a four-cycle induction course of 177Lu-octreotate with quantitative SPECT/CT-based dosimetry. The IA was personalized according to the glomerular filtration rate and the body surface area for the first cycle, and according to the prior renal Gy/GBq for the subsequent cycles. The prescribed renal absorbed dose of 23 Gy was reduced by 25-50% in case of significant renal or haematological impairment. Responders were allowed to receive consolidation or maintenance cycles, for each of which 6 Gy to the kidney were prescribed. We simulated the empiric PRRT regime by fixing the IA at 7.4 GBq per cycle, with the same percentage reductions as above. Radiological, molecular imaging, biochemical, and quality of life responses, as well as safety, were assessed. RESULTS Fifty-two patients underwent 171 cycles. In 34 patients who completed the induction course, a median cumulative IA of 36.1 (range, 6.3-78.6) GBq was administered, and the median cumulative kidney and maximum tumour absorbed doses were 22.1 (range, 8.3-24.3) Gy and 185.7 (range: 15.2-443.1) Gy respectively. Compared with the simulated fixed-IA induction regime, there was a median 1.26-fold increase (range, 0.47-2.12 fold) in the cumulative maximum tumour absorbed dose, which was higher in 85.3% of patients. In 39 assessable patients, the best objective response was partial response in nine (23.1%), minor response in 14 (35.9%), stable disease in 13 (33.3%) and progressive disease in three patients (7.7%). In particular, 11 of 13 patients (84.6%) with pancreatic NET had partial or minor response. The global health status/quality of life score significantly increased in 50% of patients. Acute and subacute side-effects were all of grade 1 or 2, and the most common were nausea (in 32.7% of patients) and fatigue (in 30.8% of patients) respectively. Subacute grade 3 or 4 toxicities occurred in less than 10% of patients, with the exception of lymphocytopenia in 51.9% of patients, without any clinical consequences however. No patient experienced severe renal toxicity. CONCLUSIONS Personalized PRRT makes it possible to safely increase tumour irradiation in the majority of patients. Our first results indicate a favourable tolerance profile, which appears similar to that of the empiric regime. The response rates are promising, in particular in patients with NET of pancreatic origin.
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Affiliation(s)
- Michela Del Prete
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada.,Cancer Research Center, Université Laval, Quebec City, Canada.,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada
| | - Frédéric Arsenault
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada.,Cancer Research Center, Université Laval, Quebec City, Canada.,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada
| | - Nassim Saighi
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada.,Cancer Research Center, Université Laval, Quebec City, Canada.,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada
| | - Louis-Olivier Bouchard
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Radiology, Department of Medical Imaging, CHU de Québec - Université Laval, Quebec City, Canada
| | - Alexis Beaulieu
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada.,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada. .,Division of Nuclear Medicine, Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, G1R 2J6, Canada. .,Cancer Research Center, Université Laval, Quebec City, Canada. .,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada.
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Del Prete M, Arsenault F, Saighi N, Zhao W, Buteau FA, Celler A, Beauregard JM. Accuracy and reproducibility of simplified QSPECT dosimetry for personalized 177Lu-octreotate PRRT. EJNMMI Phys 2018; 5:25. [PMID: 30318563 PMCID: PMC6186532 DOI: 10.1186/s40658-018-0224-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022] Open
Abstract
Background Routine dosimetry is essential for personalized 177Lu-octreotate peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumors (NETs), but practical and robust dosimetry methods are needed for wide clinical adoption. The aim of this study was to assess the accuracy and inter-observer reproducibility of simplified dosimetry protocols based on quantitative single-photon emission computed tomography (QSPECT) with a limited number of scanning time points. We also updated our personalized injected activity (IA) prescription scheme. Methods Seventy-nine NET patients receiving 177Lu-octreotate therapy (with a total of 279 therapy cycles) were included in our study. Three-time-point (3TP; days 0, 1, and 3) QSPECT scanning was performed following each therapy administration. Dosimetry was obtained using small volumes of interest activity concentration sampling for the kidney, the bone marrow and the tumor having the most intense uptake. Accuracy of the simplified dosimetry based on two-time-point (2TP; days 1 and 3, monoexponential fit) or a single-time-point (1TPD3; day 3) scanning was assessed, as well as that of hybrid methods based on 2TP for the first cycle and 1TP (day 1 or 3; 2TP/1TPD1 and 2TP/1TPD3, respectively) or no imaging at all (based on IA only; 2TP/no imaging (NI)) for the subsequent induction cycles. The inter-observer agreement was evaluated for the 3TP, 2TP, and hybrid 2TP/1TPD3 methods using a subset of 60 induction cycles (15 patients). The estimated glomerular filtration rate (eGFR), body size descriptors (weight, body surface area (BSA), lean body weight (LBW)), and products of both were assessed for their ability to predict IA per renal absorbed dose at the first cycle. Results The 2TP dosimetry estimates correlated highly with those from the 3TP data for all tissues (Spearman r > 0.99, P < 0.0001) with small relative errors between the methods, particularly for the kidney and the tumor, with median relative errors not exceeding 2% and interdecile ranges spanning over less than 6% and 4%, respectively, for the per-cycle and cumulative estimates. For the bone marrow, the errors were slightly greater (median errors < 6%, interdecile ranges < 14%). Overall, the strength of correlations of the absorbed dose estimates from the simplified methods with those from the 3TP scans tended to progressively decrease, and the relative errors to increase, in the following order: 2TP, 2TP/1TPD3, 1TPD3, 2TP/1TPD1, and 2TP/NI. For the tumor, the 2TP/NI scenario was highly inaccurate due to the interference of the therapeutic response. There was an excellent inter-observer agreement between the three observers, in particular for the renal absorbed dose estimated using the 3TP and 2TP methods, with mean errors lesser than 1% and standard deviations of 5% or lower. The eGFR · LBW and eGFR · BSA products best predicted the ratio of IA to the renal dose (GBq/Gy) for the first cycle (Spearman r = 0.41 and 0.39, respectively; P < 0.001). For the first cycle, the personalized IA proportional to eGFR · LBW or eGFR · BSA decreased the range of delivered renal absorbed dose between patients as compared with the fixed IA. For the subsequent cycles, the optimal personalized IA could be determined based on the prior cycle renal GBq/Gy with an error of less than 21% in 90% of patients. Conclusions A simplified dosimetry protocol based on two-time-point QSPECT scanning on days 1 and 3 post-PRRT provides reproducible and more accurate dose estimates than the techniques relying on a single time point for non-initial or all cycles and results in limited patient inconvenience as compared to protocols involving scanning at later time points. Renal absorbed dose over the 4-cycle induction PRRT course can be standardized by personalizing IA based on the product of eGFR with LBW or BSA for the first cycle and on prior renal dosimetry for the subsequent cycles.
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Affiliation(s)
- Michela Del Prete
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Frédéric Arsenault
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Nassim Saighi
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Wei Zhao
- Medical Imaging Research Group, University of British Columbia, Vancouver, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada.,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada
| | - Anna Celler
- Medical Imaging Research Group, University of British Columbia, Vancouver, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Jean-Mathieu Beauregard
- Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada. .,Department of Medical Imaging and Oncology Branch of CHU de Québec Research Center, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City, QC, G1R 2J6, Canada.
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Purohit NK, Shah RG, Adant S, Hoepfner M, Shah GM, Beauregard JM. Potentiation of 177Lu-octreotate peptide receptor radionuclide therapy of human neuroendocrine tumor cells by PARP inhibitor. Oncotarget 2018; 9:24693-24706. [PMID: 29872498 PMCID: PMC5973847 DOI: 10.18632/oncotarget.25266] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/06/2018] [Indexed: 01/02/2023] Open
Abstract
For patients with inoperable neuroendocrine tumors (NETs) expressing somatostatin receptors, peptide receptor radionuclide therapy (PRRT) with 177Lu-[DOTA0-Tyr3]-octreotate (177Lu-octreotate) is one of the most promising targeted therapeutic options but it rarely achieves cure. Therefore, different approaches are being tested to increase the efficacy of 177Lu-octreotate PRRT in NET patients. Using the gastroenteropancreatic BON-1 and the bronchopulmonary NCI-H727 as NET cell models, here we report that pharmacological inhibitors of DNA repair-associated enzyme poly(ADP-ribose) polymerase-1 (PARPi) potentiate the cytotoxic effect of 177Lu-octreotate on 2D monolayer and 3D spheroid models of these two types of NET cells. PARPi mediates this effect by enhancing 177Lu-octreotate-induced cell cycle arrest and cell death. Thus, the use of PARPi may offer a novel option for improving the therapeutic efficacy of 177Lu-octreotate PRRT of NETs.
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Affiliation(s)
- Nupur K. Purohit
- Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Quebec City, Canada
- Cancer Research Center, Université Laval, Quebec City, Canada
- Neurosciences and Oncology Branches of CHU de Québec, Université Laval Research Center, Quebec City, Canada
| | - Rashmi G. Shah
- Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Quebec City, Canada
- Cancer Research Center, Université Laval, Quebec City, Canada
- Neurosciences and Oncology Branches of CHU de Québec, Université Laval Research Center, Quebec City, Canada
| | - Samuel Adant
- Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Quebec City, Canada
- Cancer Research Center, Université Laval, Quebec City, Canada
- Neurosciences and Oncology Branches of CHU de Québec, Université Laval Research Center, Quebec City, Canada
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada
- Oncology Branch of CHU de Québec, Université Laval Research Center, Quebec City, Canada
| | - Michael Hoepfner
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Girish M. Shah
- Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Quebec City, Canada
- Cancer Research Center, Université Laval, Quebec City, Canada
- Neurosciences and Oncology Branches of CHU de Québec, Université Laval Research Center, Quebec City, Canada
| | - Jean-Mathieu Beauregard
- Cancer Research Center, Université Laval, Quebec City, Canada
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada
- Oncology Branch of CHU de Québec, Université Laval Research Center, Quebec City, Canada
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Lavallée E, Bergeron M, Buteau FA, Blouin AC, Duchesnay N, Dujardin T, Tiguert R, Lacombe L, Fradet V, Makao-Nguile M, Fradet Y, Beauregard JM, Pouliot F. Increased Prostate Cancer Glucose Metabolism Detected by 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Localised Gleason 8-10 Prostate Cancers Identifies Very High-risk Patients for Early Recurrence and Resistance to Castration. Eur Urol Focus 2018; 5:998-1006. [PMID: 29609897 DOI: 10.1016/j.euf.2018.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to stage prostate cancer (PCa) is limited. However, Gleason 8-10 PCa and more aggressive metastatic PCa have been shown to exhibit a higher glycolytic activity. OBJECTIVE To evaluate the potential of intraprostatic FDG uptake to prognose Gleason 8-10 PCa patients prior to prostatectomy, based on tumour intrinsic biology. DESIGN, SETTING, AND PARTICIPANTS FDG-PET/CT and a bone scan were performed as a staging procedure prior to prostatectomy in 148 consecutive patients diagnosed with PCa with a Gleason sum of ≥8 at biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The FDG-PET/CT images were blind reviewed. Lymph node (LN) metastasis and intraprostatic FDG uptake were systematically recorded, and correlated with the patients' clinicopathological characteristics. RESULTS AND LIMITATIONS FDG-PET/CT detected foci of intraprostatic FDG uptake in 66% of patients. An intraprostatic FDG uptake of maximum intraprostatic standardised uptake value (SUVmax) of ≥4.6 was statistically significantly associated with a higher pathological Gleason ≥8, extracapsular extension, seminal vesicle invasion, and pathological LN metastasis. In multivariate analysis, an intraprostatic SUVmax of ≥4.6 was associated with a two-fold increased risk of biochemical recurrence in the year following surgery. Patients with an intraprostatic SUVmax of ≥4.6 had estimated median biochemical recurrence-free survival (BFS) of 11.3mo compared with 49.5mo for those with a lower SUVmax. Finally, high intraprostatic FDG uptake was associated with shorter time to castration resistance following radical prostatectomy (RP). CONCLUSIONS Preoperative intraprostatic FDG uptake is an integrator of adverse pathological prognostic factors, predicting BFS and castration resistance following RP in patients with a Gleason score ≥8 PCa at biopsy. These results support the use of preoperative FDG-PET/CT as a tool to distinguish at diagnosis very high-risk Gleason 8-10 PCa patients in whom novel neoadjuvant or adjuvant therapies should be explored. PATIENT SUMMARY This study shows that an increased use of glucose by prostate cancer cells detected by 18F-fluorodeoxyglucose positron emission tomography molecular imaging can identify aggressive prostate cancers.
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Affiliation(s)
- Etienne Lavallée
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Michelle Bergeron
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - François-Alexandre Buteau
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Annie-Claude Blouin
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Nicolas Duchesnay
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Thierry Dujardin
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Rabi Tiguert
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Louis Lacombe
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Vincent Fradet
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Molière Makao-Nguile
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Yves Fradet
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Jean-Mathieu Beauregard
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada
| | - Frédéric Pouliot
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada.
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Uribe CF, Esquinas PL, Tanguay J, Gonzalez M, Gaudin E, Beauregard JM, Celler A. Accuracy of 177Lu activity quantification in SPECT imaging: a phantom study. EJNMMI Phys 2017; 4:2. [PMID: 28063068 PMCID: PMC5218957 DOI: 10.1186/s40658-016-0170-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/20/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of the study is to assess accuracy of activity quantification of 177Lu studies performed according to recommendations provided by the committee on Medical Internal Radiation Dose (MIRD) pamphlets 23 and 26. The performances of two scatter correction and three segmentation methods were compared. Additionally, the accuracy of tomographic and planar methods for determination of the camera normalization factor (CNF) was evaluated. Eight phantoms containing inserts of different sizes and shapes placed in air, water, and radioactive background were scanned using a Siemens SymbiaT SPECT/CT camera. Planar and tomographic scans with 177Lu sources were used to measure CNF. Images were reconstructed with our SPEQToR software using resolution recovery, attenuation, and two scatter correction methods (analytical photon distribution interpolated (APDI) and triple energy window (TEW)). Segmentation was performed using a fixed threshold method for both air and cold water scans. For hot water experiments three segmentation methods were compared as folows: a 40% fixed threshold, segmentation based on CT images, and our iterative adaptive dual thresholding (IADT). Quantification error, defined as the percent difference between experimental and true activities, was evaluated. RESULTS Quantification error for scans in air was better for TEW scatter correction (<6%) than for APDI (<11%). This trend was reversed for scans in water (<10% for APDI and <14% for TEW). For hot water, the best results (<18% for small objects and <5% for objects >100 ml) were obtained when APDI and IADT were used for scatter correction and segmentation, respectively. Additionally, we showed that planar acquisitions with scatter correction and tomographic scans provide similar CNF values. This is an important finding because planar acquisitions are easier to perform than tomographic scans. TEW and APDI resulted in similar quantification errors with APDI showing a small advantage for objects placed in medium with non-uniform density. CONCLUSIONS Following the MIRD recommendations for data acquisition and reconstruction resulted in accurate activity quantification (errors <5% for large objects). However, techniques for better organ/tumor segmentation must still be developed.
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Affiliation(s)
- Carlos F Uribe
- Medical Imaging Research Group, Department of Radiology, University of British Columbia, Vancouver, British Colombia, Canada.
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Colombia, Canada.
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Colombia, Canada.
| | - Pedro L Esquinas
- Medical Imaging Research Group, Department of Radiology, University of British Columbia, Vancouver, British Colombia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Colombia, Canada
| | - Jesse Tanguay
- Medical Imaging Research Group, Department of Radiology, University of British Columbia, Vancouver, British Colombia, Canada
| | - Marjorie Gonzalez
- Vancouver Coastal Health Authority, Vancouver, British Colombia, Canada
| | - Emilie Gaudin
- Department of Physics, Engineering Physics and Optics, Université Laval, Quebec City, Quebec, Canada
| | - Jean-Mathieu Beauregard
- Department of Medical Imaging, CHU de Quebec-Université Laval, Quebec City, Quebec, Canada
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Anna Celler
- Medical Imaging Research Group, Department of Radiology, University of British Columbia, Vancouver, British Colombia, Canada
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Bensaïdane MR, Beauregard JM, Poulin S, Buteau FA, Guimond J, Bergeron D, Verret L, Fortin MP, Houde M, Bouchard RW, Soucy JP, Laforce R. Clinical Utility of Amyloid PET Imaging in the Differential Diagnosis of Atypical Dementias and Its Impact on Caregivers. J Alzheimers Dis 2017; 52:1251-62. [PMID: 27104896 DOI: 10.3233/jad-151180] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent studies have supported a role for amyloid positron emission tomography (PET) imaging in distinguishing Alzheimer's disease (AD) pathology from other pathological protein accumulations leading to dementia. We investigated the clinical utility of amyloid PET in the differential diagnosis of atypical dementia cases and its impact on caregivers. Using the amyloid tracer 18F-NAV4694, we prospectively scanned 28 patients (mean age 59.3 y, s.d. 5.8; mean MMSE 21.4, s.d. 6.0) with an atypical dementia syndrome. Following a comprehensive diagnostic workup (i.e., history taking, neurological examination, blood tests, neuropsychological evaluation, MRI, and FDG-PET), no certain diagnosis could be arrived at. Amyloid PET was then conducted and classified as positive or negative. Attending physicians were asked to evaluate whether this result led to a change in diagnosis or altered management. They also reported their degree of confidence in the diagnosis. Caregivers were met after disclosure of amyloid PET results and completed a questionnaire/interview to assess the impact of the scan. Our cohort was evenly divided between positive (14/28) and negative (14/28) 18F-NAV4694 cases. Amyloid PET resulted in a diagnostic change in 9/28 cases (32.1%: 17.8% changed from AD to non-AD, 14.3% from non-AD to AD). There was a 44% increase in diagnostic confidence. Altered management occurred in 71.4% (20/28) of cases. Knowledge of amyloid status improved caregivers' outcomes in all domains (anxiety, depression, disease perception, future anticipation, and quality of life). This study suggests a useful additive role for amyloid PET in atypical cases with an unclear diagnosis beyond the extensive workup of a tertiary memory clinic. Amyloid PET increased diagnostic confidence and led to clinically significant alterations in management. The information gained from that test was well received by caregivers and encouraged spending quality time with their loved ones.
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Affiliation(s)
| | | | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada
| | | | - Jean Guimond
- Département d'imagerie médicale, CHU de Québec, QC, Canada
| | - David Bergeron
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada.,Département des Sciences Neurologiques, Université Laval, QC, Canada
| | | | - Michèle Houde
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada
| | - Rémi W Bouchard
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada.,Département des Sciences Neurologiques, Université Laval, QC, Canada
| | | | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, QC, Canada.,Département des Sciences Neurologiques, Université Laval, QC, Canada
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Espagnet R, Frezza A, Martin JP, Hamel LA, Lechippey L, Beauregard JM, Després P. A CZT-based blood counter for quantitative molecular imaging. EJNMMI Phys 2017; 4:18. [PMID: 28577291 PMCID: PMC5457380 DOI: 10.1186/s40658-017-0184-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/02/2017] [Indexed: 11/30/2022] Open
Abstract
Background Robust quantitative analysis in positron emission tomography (PET) and in single-photon emission computed tomography (SPECT) typically requires the time-activity curve as an input function for the pharmacokinetic modeling of tracer uptake. For this purpose, a new automated tool for the determination of blood activity as a function of time is presented. The device, compact enough to be used on the patient bed, relies on a peristaltic pump for continuous blood withdrawal at user-defined rates. Gamma detection is based on a 20 × 20 × 15 mm3 cadmium zinc telluride (CZT) detector, read by custom-made electronics and a field-programmable gate array-based signal processing unit. A graphical user interface (GUI) allows users to select parameters and easily perform acquisitions. Results This paper presents the overall design of the device as well as the results related to the detector performance in terms of stability, sensitivity and energy resolution. Results from a patient study are also reported. The device achieved a sensitivity of 7.1 cps/(kBq/mL) and a minimum detectable activity of 2.5 kBq/ml for 18F. The gamma counter also demonstrated an excellent stability with a deviation in count rates inferior to 0.05% over 6 h. An energy resolution of 8% was achieved at 662 keV. Conclusions The patient study was conclusive and demonstrated that the compact gamma blood counter developed has the sensitivity and the stability required to conduct quantitative molecular imaging studies in PET and SPECT.
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Affiliation(s)
- Romain Espagnet
- Department of Physics, Engineering Physics and Optics and Cancer Research Center, Université Laval, Quebec City, G1V 0A6, QC, Canada
| | - Andrea Frezza
- Department of Physics, Engineering Physics and Optics and Cancer Research Center, Université Laval, Quebec City, G1V 0A6, QC, Canada
| | - Jean-Pierre Martin
- Department of Physics, Université de Montréal, C.P. 6128, Montréal, H3C 3J7, QC, Canada
| | - Louis-André Hamel
- Department of Physics, Université de Montréal, C.P. 6128, Montréal, H3C 3J7, QC, Canada
| | - Laëtitia Lechippey
- Department of Physics, Engineering Physics and Optics and Cancer Research Center, Université Laval, Quebec City, G1V 0A6, QC, Canada
| | - Jean-Mathieu Beauregard
- Department of Medical Imaging and Research Center of CHU de Québec - Université Laval, Quebec City, G1R 2J6, QC, Canada.,Department of Radiology and Nuclear medicine and Cancer Research Center, Université Laval, Quebec CityQC, G1V 0A6, Canada
| | - Philippe Després
- Department of Physics, Engineering Physics and Optics and Cancer Research Center, Université Laval, Quebec City, G1V 0A6, QC, Canada. .,Department of Radiation Oncology and Research Center of CHU de Québec - Université Laval, Quebec City, G1R 2J6, QC, Canada.
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Morin F, Beauregard JM, Bergeron M, Nguile Makao M, Lacombe L, Fradet V, Fradet Y, Pouliot F. Metabolic Imaging of Prostate Cancer Reveals Intrapatient Intermetastasis Response Heterogeneity to Systemic Therapy. Eur Urol Focus 2017; 3:639-642. [PMID: 28753860 DOI: 10.1016/j.euf.2017.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/05/2017] [Accepted: 02/10/2017] [Indexed: 12/17/2022]
Abstract
Although intrapatient heterogeneity of prostate cancer (PCa) has recently been characterized via genomic and transcriptomic studies, the heterogeneity of systemic treatment responses has yet to be reported or imaged. Our objective was to evaluate the intrapatient intermetastasis response to systemic treatment among patients with metastatic PCa. We evaluated the metabolic response for each individual metastatic lesion (n=165) in 15 patients with metastatic PCa who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography before and at least 3 mo after initiation of a systemic therapy that did not change in that period. Intermetastasis heterogeneity was defined as opposite metabolic responses for at least two metastases from the same compartment (bone or soft tissue) between the two time points. We found intrapatient intermetastasis response heterogeneity in 40% of the cases in our retrospective series. Our results suggest that systemic therapies can induce heterogeneous responses among individual metastases in patients with PCa, supporting the polyclonal evolution of PCa in advanced disease. Molecular imaging may thus be useful in identifying clinical resistance early after therapy initiation and could also allow targeted biopsy of resistant clones for molecular analysis. PATIENT SUMMARY Systemic therapies can lead to heterogeneous responses in individual metastases of prostate cancer in a patient. Molecular imaging may be useful for identifying heterogeneity and could allow targeted biopsy for molecular analysis or therapy.
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Affiliation(s)
- Fannie Morin
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Quebec City, Canada
| | - Jean-Mathieu Beauregard
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Quebec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Quebec City, Canada
| | - Michelle Bergeron
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Quebec City, Canada
| | - Molière Nguile Makao
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Quebec City, Canada
| | - Louis Lacombe
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Quebec City, Canada
| | - Vincent Fradet
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Quebec City, Canada
| | - Yves Fradet
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Quebec City, Canada
| | - Frédéric Pouliot
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Quebec City, Canada.
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Morin F, Beauregard JM, Bergeron M, Nguilé-Makao M, Lacombe L, Fradet V, Fradet Y, Pouliot F. Serial FDG-PET imaging of metastatic prostate cancers reveals intrapatient intermetastases polyclonality through same patient heterogeneous responses to systemic therapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.e590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e590 Background: Although intrapatient prostate cancer (PCa) metastasis polyclonality has been recently characterized by genomic and transcriptomic studies, systemic treatment response heterogeneity has yet to be reported or imaged. It remains unknown if polyclonal differentiation leads to heterogeneous treatment responses between metastases in a single patient undergoing therapy. Methods: Between 2010 and 2015, fifteen patients with metastatic PCa were imaged by FDG-PET/CT before and during systemic therapy, and metabolic response was recorded for individual metastatic lesions. Intermetastasis heterogeneity was defined by opposite metabolic responses of at least two metastases from the same compartment (bone or soft tissue) between the two scans. We examined intrapatient intermetastasis heterogeneity of response to systemic therapy based on the assessment of metabolic response in a total of 165 individual lesions (change in SUVmax, complete response, or new lesion). Change in total lesion glycolysis (TLG) was assessed for each patient. Biochemical response and progression-free survival (PFS) were also recorded. Results: Intrapatient intermetastasis response heterogeneity was found in 40% of cases. In univariate statistical analysis, response heterogeneity was associated with a decrease in PFS (p-value= 0.001), but not with age, CRPC status, Gleason score, PSA-DT, TLG, maximum SUVmax, or sum of SUVmax. In two cases, new metastasis and complete metastasis responses were observed in the same patients. Conclusions: Our results suggest that systemic therapies can induce heterogeneous responses among individual metastases in patients with PCa, supporting the polyclonal evolution of PCa in advanced disease. Molecular imaging may thus be useful to identify clinical resistance earlier after therapy initiation and could also enable targeted biopsy of resistant clones for molecular analysis.
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Affiliation(s)
- Fannie Morin
- CHU de Quebec and Laval University, Quebec, QC, Canada
| | | | | | | | - Louis Lacombe
- CHU de Quebec and Laval University, Quebec, QC, Canada
| | | | - Yves Fradet
- CHU de Quebec and Laval University, Quebec, QC, Canada
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Abstract
Over the last decade, 18F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT) has gained in popularity for the staging and restaging of patients with prostate cancer (PCa). However, despite abundant literature on the topic, there is a lack of publications on how to actually interpret FCH-PET/CT in a clinical setting. Here we propose a practical, TNM-oriented approach to read FCH-PET/CT, with notes on procedure technique, image display, review sequence and report structure. The purpose of this article is to provide guidance to radiologists, nuclear medicine physicians and residents who are new to FCH-PET/CT, as well as to propose an alternate approach to more experienced physicians.
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Affiliation(s)
- Jean-Mathieu Beauregard
- Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City (QC), G1R 2J6, Canada. .,Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada. .,Oncology Branch, CHU de Québec - Université Laval Research Center, Quebec City, Canada.
| | - Alexis Beaulieu
- Department of Medical Imaging, CHU de Québec - Université Laval, 11 côte du Palais, Quebec City (QC), G1R 2J6, Canada.,Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Canada
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Laforce R, Bensaidane MR, Beauregard JM, Poulin S, Bergeron D, Verret L, Fortin MP, Houde M, Soucy JP, Bouchard RW. P2‐394: Impact of Disclosing Amyloid Status on Caregivers: A Memory Clinic Study. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Robert Laforce
- Clinique Interdisciplinaire de Memoire du CHU de QuebecQuebec Canada
- Universite LavalQuebecQC Canada
| | - Mohamed Reda Bensaidane
- Clinique Interdisciplinaire de Memoire du CHU de QuebecQuebec Canada
- Universite LavalQuebecQC Canada
| | | | - Stephane Poulin
- Clinique Interdisciplinaire de Memoire du CHU de QuebecQuebec Canada
| | - David Bergeron
- Clinique Interdisciplinaire de Memoire du CHU de QuebecQuebec Canada
- Universite LavalQuebecQC Canada
| | - Louis Verret
- Clinique Interdisciplinaire de Memoire du CHU de QuebecQuebec Canada
| | | | - Michele Houde
- Clinique Interdisciplinaire de Memoire du CHU de QuebecQuebec Canada
- Universite LavalQuebecQC Canada
| | | | - Remi W. Bouchard
- Clinique Interdisciplinaire de Memoire du CHU de QuebecQuebec Canada
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Bergeron D, Beauregard JM, Guimond J, Fortin MP, Houde M, Poulin S, Verret L, Bouchard RW, Laforce R. Clinical Impact of a Second FDG-PET in Atypical/Unclear Dementia Syndromes. J Alzheimers Dis 2015; 49:695-705. [DOI: 10.3233/jad-150302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David Bergeron
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, PQ, Canada
| | | | - Jean Guimond
- Service de médecine nucléaire, Institut de Cardiologie et de Pneumologie de Québec (IUCPQ), PQ, Canada
| | | | - Michèle Houde
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, PQ, Canada
| | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, PQ, Canada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, PQ, Canada
- Département des Sciences Neurologiques, Université Laval, PQ, Canada
| | - Rémi W. Bouchard
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, PQ, Canada
- Département des Sciences Neurologiques, Université Laval, PQ, Canada
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME), CHU de Québec, PQ, Canada
- Département des Sciences Neurologiques, Université Laval, PQ, Canada
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Laforce R, Bensaïdane MR, Bouchard RW, Fortin MP, Houde M, Rosa-Neto P, Poulin S, Verret L, Soucy JP, Beauregard JM. FTS‐04‐03: Clinical utility of amyloid PET in the differential diagnosis of atypical dementias and its impact on caregivers. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.07.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert Laforce
- Clinique Interdisciplinaire de mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
| | - Mohamed Reda Bensaïdane
- Clinique Interdisciplinaire de mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
| | - Remi W. Bouchard
- Clinique Interdisciplinaire de mémoire du CHU de QuébecQuébecQCCanada
| | | | - Michèle Houde
- Clinique Interdisciplinaire de mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
| | - Pedro Rosa-Neto
- Centre for Studies on Prevention of Alzheimer's Disease (StoP‐AD Centre)Douglas Mental Health InstituteMontrealQCCanada
- Douglas Hospital Research CentreMontrealQCCanada
- McGill Centre for Studies in AgingMontrealQCCanada
- Translational Imaging LaboratoryMontrealQCCanada
| | - Stéphane Poulin
- Clinique Interdisciplinaire de mémoire du CHU de QuébecQuébecQCCanada
| | - Louis Verret
- Clinique Interdisciplinaire de mémoire du CHU de QuébecQuébecQCCanada
| | - Jean-Paul Soucy
- McConnell Brain Imaging CentreMontréalQCCanada
- McGill UniversityMontréalQCCanada
- Université de MontréalMontréalQCCanada
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Bensaïdane MR, Bouchard RW, Fortin MP, Houde M, Neto PR, Poulin S, Verret L, Soucy JP, Beauregard JM, Laforce R. IC‐P‐007: Clinical utility of amyloid imaging in the differential diagnosis of atypical/unclear dementias and its impact on caregivers. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Mohamed Reda Bensaïdane
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
| | - Remi W. Bouchard
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
| | | | - Michèle Houde
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
| | | | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
| | | | | | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
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Bensaïdane MR, Bouchard RW, Fortin MP, Houde M, Neto PR, Poulin S, Verret L, Soucy JP, Beauregard JM, Laforce R. P1‐173: Clinical utility of amyloid imaging in the differential diagnosis of atypical/unclear dementias and its impact on caregivers. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Mohamed Reda Bensaïdane
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
| | - Remi W. Bouchard
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
| | | | - Michèle Houde
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
| | | | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
| | | | | | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
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Beauregard JM, Blouin AC, Fradet V, Caron A, Fradet Y, Lemay C, Lacombe L, Dujardin T, Tiguert R, Rimac G, Bouchard F, Pouliot F. FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade prostate cancer at biopsy. Cancer Imaging 2015; 15:2. [PMID: 25889163 PMCID: PMC4352558 DOI: 10.1186/s40644-015-0038-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/20/2015] [Indexed: 12/04/2022] Open
Abstract
Background The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in prostate cancer (PCa) has not been well defined yet. Because high-grade PCa tends to exhibit increased glycolytic rate, FDG-PET/CT could be useful in this setting. The aim of this study was to assess the value of FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade PCa at biopsy. Methods Fifty-four patients with a Gleason sum ≥8 PCa at biopsy underwent FDG-PET/CT as part of the staging workup. Thirty-nine patients underwent radical prostatectomy (RP) and pelvic lymph node (LN) dissection, 2 underwent LN dissection only, and 13 underwent non-surgical treatments. FDG-PET/CT findings from clinical reports, blinded reading and quantitative analysis were correlated with clinico-pathological characteristics at RP. Results Suspicious foci of increased FDG uptake were found in the prostate, LNs and bones in 44, 13 and 6% of patients, respectively. Higher clinical stage, post-RP Gleason sum and pattern, and percentage of cancer involvement within the prostate were significantly associated with the presence of intraprostatic FDG uptake (IPFU) (P < 0.05 in all cases). Patients without IPFU who underwent RP were downgraded to Gleason ≤7 in 84.6% of cases, as compared to 30.8% when IPFU was reported (P = 0.003). Qualitative and quantitative IPFU were significantly positively correlated with post-RP Gleason pattern and sum, and pathological T stage. Absence and presence of IPFU were associated with a median 5-year cancer-free survival probability of 70.2 and 26.9% (P = 0.0097), respectively, using the CAPRA-S prognostic tool. Conclusion These results suggest that, among patients with a high-grade PCa at biopsy, FDG-PET/CT could improve pre-treatment prognostic stratification by predicting primary PCa pathological grade and survival probability following RP.
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Affiliation(s)
- Jean-Mathieu Beauregard
- Division of Nuclear Medicine, Department of Radiology and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Annie-Claude Blouin
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Vincent Fradet
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - André Caron
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Yves Fradet
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Claude Lemay
- Centre hospitalier du Christ-Roi, Quebec City, Canada.
| | - Louis Lacombe
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Thierry Dujardin
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Rabi Tiguert
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Goran Rimac
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Frédérick Bouchard
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
| | - Frédéric Pouliot
- Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. .,Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada.
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Jackson PA, Beauregard JM, Hofman MS, Kron T, Hogg A, Hicks RJ. An automated voxelized dosimetry tool for radionuclide therapy based on serial quantitative SPECT/CT imaging. Med Phys 2014; 40:112503. [PMID: 24320462 DOI: 10.1118/1.4824318] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To create an accurate map of the distribution of radiation dose deposition in healthy and target tissues during radionuclide therapy. METHODS Serial quantitative SPECT∕CT images were acquired at 4, 24, and 72 h for 28 (177)Lu-octreotate peptide receptor radionuclide therapy (PRRT) administrations in 17 patients with advanced neuroendocrine tumors. Deformable image registration was combined with an in-house programming algorithm to interpolate pharmacokinetic uptake and clearance at a voxel level. The resultant cumulated activity image series are comprised of values representing the total number of decays within each voxel's volume. For PRRT, cumulated activity was translated to absorbed dose based on Monte Carlo-determined voxel S-values at a combination of long and short ranges. These dosimetric image sets were compared for mean radiation absorbed dose to at-risk organs using a conventional MIRD protocol (OLINDA 1.1). RESULTS Absorbed dose values to solid organs (liver, kidneys, and spleen) were within 10% using both techniques. Dose estimates to marrow were greater using the voxelized protocol, attributed to the software incorporating crossfire effect from nearby tumor volumes. CONCLUSIONS The technique presented offers an efficient, automated tool for PRRT dosimetry based on serial post-therapy imaging. Following retrospective analysis, this method of high-resolution dosimetry may allow physicians to prescribe activity based on required dose to tumor volume or radiation limits to healthy tissue in individual patients.
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Affiliation(s)
- Price A Jackson
- Department of Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne 3002, Australia
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Montégiani JF, Gaudin É, Jackson PA, Beauregard JM, Després P. Sci-Thur AM: YIS - 03: irtGPUMCD: a new GPU-calculated dosimetry code for 177
Lu-octreotate radionuclide therapy of neuroendocrine tumors. Med Phys 2014. [DOI: 10.1118/1.4894892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gaudin É, Montégiani JF, Beauregard JM, Després P. Sci-Thur PM: Imaging - 05: Calibration of a SPECT/CT camera for quantitative SPECT with 99m
Tc. Med Phys 2014. [DOI: 10.1118/1.4894978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kashyap R, Jackson P, Hofman MS, Eu P, Beauregard JM, Zannino D, Hicks RJ. Rapid blood clearance and lack of long-term renal toxicity of 177Lu-DOTATATE enables shortening of renoprotective amino acid infusion. Eur J Nucl Med Mol Imaging 2013; 40:1853-60. [PMID: 23864305 DOI: 10.1007/s00259-013-2504-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/28/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of the study was to investigate the feasibility of shortening the recommended 4-h renoprotective amino acid infusion in patients receiving peptide receptor chemoradionuclide therapy (PRCRT) using radiosensitizing 5-fluorouracil. We evaluated the clearance of radiopeptide from the blood, long-term nephrotoxicity in patients undergoing PRCRT with the conventional 4-h amino acid infusion and renal uptake in patients receiving an abbreviated infusion. METHODS The whole-blood clearance of (177)Lu-DOTA-octreotate (LuTate) was measured in 13 patients receiving PRCRT. A retrospective analysis of short-term and long-term changes in glomerular filtration rate (GFR) in 96 consecutive patients receiving a 4-h infusion was performed. Renal LuTate retention estimated using quantitative SPECT/CT in 22 cycles delivered with a 2.5-h amino acid infusion was compared with that in 72 cycles with the 4-h infusion. RESULTS LuTate demonstrated biexponential blood clearance with an initial clearance half-time of 21 min. Approximately 88 % of blood activity was cleared within 2 h. With the 4-h protocol, there was no significant change in GFR (1.2 ml/min mean increase from baseline; 95 % CI -6.9 to 4.4 ml/min) and no grade 3 or 4 nephrotoxicity at the end of induction PRCRT. The long-term decline in GFR after a median follow up of 22 months was 2.2 ml/min per year. There was no significant difference in the renal LuTate retention measured in patients receiving a 2.5-h amino acid infusion compared to those who had a 4-h infusion. CONCLUSION The greatest renal exposure to circulating radiopeptide occurs in the first 1 - 2 h after injection. This, combined with the safety of LuTate PRCRT, allows consideration of an abbreviated amino acid infusion, increasing patient convenience and reducing human resource allocation.
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Affiliation(s)
- Raghava Kashyap
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, St Andrews Place, Melbourne, 3002, Australia,
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Lasnon C, Hicks RJ, Beauregard JM, Milner A, Paciencia M, Guizard AV, Bardet S, Gervais R, Lemoel G, Zalcman G, Aide N. Impact of point spread function reconstruction on thoracic lymph node staging with 18F-FDG PET/CT in non-small cell lung cancer. Clin Nucl Med 2013; 37:971-6. [PMID: 22899197 DOI: 10.1097/rlu.0b013e318251e3d1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The aim of the present study was to evaluate the impact of point spread function (PSF) reconstruction on quantitative values and diagnostic accuracy of FDG PET/CT for nodal staging in non-small cell lung cancer. PATIENTS AND METHODS Fifty-eight consecutive PET/CT examinations were reconstructed with both ordered subset expectation maximization (OSEM) and PSF algorithms. Two readers independently performed a randomized blinded review of PET/CT examinations and gave a nodal status (N0, N1, N2, or N3) to each PET data set. When discordant, a consensus was reached with a third reader. Sensitivity, specificity, positive and negative predictive values (NPV), and positive and negative likelihood ratios (LRs) were assessed and compared using a McNemar test. All PET data sets were then independently analyzed to extract quantitative PET values in 208 nodes and compare them using Bland-Altman analysis. RESULTS Bland-Altman analysis showed that, on average, PSF reconstruction increased SUVmax, SUVmean, and node/background ratios by 48%, 28%, and 27%, respectively. This increase was more marked for nodes less than 1 cm than for nodes 1 cm or greater (P < 0.0001 for SUVmax, SUVmean, and node/background ratios). Point spread function PET had higher sensitivity (97%) and NPV (92%) than OSEM PET (78% and 57%, respectively; P = 0.01 and P = 0.04, respectively). Negative LR was 0.04 for PSF PET and 0.31 for OSEM PET. CONCLUSIONS By improving activity recovery, especially for nonenlarged nodes, PSF significantly improves the sensitivity, NPV, and negative LR of FDG-PET for nodal staging in non-small cell lung cancer. These data suggest that preoperative invasive nodal staging may be omitted in the case of a negative PSF FDG-PET/CT.
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Affiliation(s)
- Charline Lasnon
- François Baclesse Cancer Centre and University Hospital PET unit, University Hospital, Caen, France
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Hofman MS, Beauregard JM, Barber TW, Neels OC, Eu P, Hicks RJ. 68Ga PET/CT Ventilation–Perfusion Imaging for Pulmonary Embolism: A Pilot Study with Comparison to Conventional Scintigraphy. J Nucl Med 2011; 52:1513-9. [DOI: 10.2967/jnumed.111.093344] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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