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Krolicki L, Kunikowska J, Cordier D, Slavova N, Koziara H, Bruchertseifer F, Maecke HR, Morgenstern A, Merlo A. Long-Term Tumor Control Following Targeted Alpha Therapy (TAT) of Low-Grade Gliomas (LGGs): A New Treatment Paradigm? Int J Mol Sci 2023; 24:15701. [PMID: 37958683 PMCID: PMC10650612 DOI: 10.3390/ijms242115701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
The median survival time has been reported to vary between 5 and 8 years in low-grade (WHO grade 2) astrocytoma, and between 10 and 15 years for grade 2 oligodendroglioma. Targeted alpha therapy (TAT), using the modified peptide vector [213Bi]Bi/[225Ac]Ac-DOTA-substance P, has been developed to treat glioblastoma (GBM), a prevalent malignant brain tumor. In order to assess the risk of late neurotoxicity, assuming that reduced tumor cell proliferation and invasion should directly translate into good responses in low-grade gliomas (LGGs), a limited number of patients with diffuse invasive astrocytoma (n = 8) and oligodendroglioma (n = 3) were offered TAT. In two oligodendroglioma patients, TAT was applied as a second-line treatment for tumor progression, 10 years after targeted beta therapy using [90Y]Y-DOTA-substance P. The radiopharmaceutical was locally injected directly into the tumor via a stereotactic insertion of a capsule-catheter system. The activity used for radiolabeling was 2-2.5 GBq of Bismuth-213 and 17 to 35 MBq of Actinium-225, mostly applied in a single fraction. The recurrence-free survival times were in the range of 2 to 16 years (median 11 years) in low-grade astrocytoma (n = 8), in which TAT was administered following a biopsy or tumor debulking. Regarding oligodendroglioma, the recurrence-free survival time was 24 years in the first case treated, and 4 and 5 years in the two second-line cases. In conclusion, TAT leads to long-term tumor control in the majority of patients with LGG, and recurrence has so far not manifested in patients with low-grade (grade 2) astrocytomas who received TAT as a first-line therapy. We conclude that targeted alpha therapy has the potential to become a new treatment paradigm in LGG.
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Affiliation(s)
- Leszek Krolicki
- Nuclear Medicine Department, Medical University of Warsaw, 02-091 Warsaw, Poland; (L.K.); (J.K.)
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, 02-091 Warsaw, Poland; (L.K.); (J.K.)
| | - Dominik Cordier
- Neurosurgery Department, University Hospital Basel, 4031 Basel, Switzerland;
| | - Nedelina Slavova
- Department of Neurology, Inselspital, University Hospital Bern, 3010 Bern, Switzerland;
| | - Henryk Koziara
- Department of Neurosurgery, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland;
| | - Frank Bruchertseifer
- European Commission, Joint Research Centre (JRC), 76125 Karlsruhe, Germany; (F.B.); (A.M.)
| | - Helmut R. Maecke
- Nuclear Medicine and Radiochemistry, University Hospital Basel, 4031 Basel, Switzerland
| | - Alfred Morgenstern
- European Commission, Joint Research Centre (JRC), 76125 Karlsruhe, Germany; (F.B.); (A.M.)
| | - Adrian Merlo
- Department of Neurosurgery, Bern and University of Basel, 4001 Basel, Switzerland
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Domínguez-Ayala M, Mínguez-Gabiña P, Paja-Fano M, Bilbao-González A, Expósito-Rodríguez A, Rodeño-Ortiz de Zarate E. The role of BRAF V600E mutation in post-surgical 131I therapy in papillary thyroid carcinoma: a study based on SPECT-CT uptake analysis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2023; 67:83-92. [PMID: 34477344 DOI: 10.23736/s1824-4785.21.03343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The BRAF V600E mutation (BRAF mut) in papillary thyroid cancer (PTC) has been associated with poor response to therapy with 131I in patients with metastases but the results in postsurgical treatment are controversial. Our main objective is to investigate the impact of the mutation on the biokinetics of the administered 131I therapy after surgery. METHODS A prospective study was designed, from July 2015 to January 2018 which included patients with PTC receiving 131I therapy after surgical treatment. To study the biokinetics of the radioiodine in postoperative thyroid remnants, SPECT-CT images were acquired so as to obtain the following variables: percentage of remnant uptake at 2 and 7 days post-administration, effective half-life and time-integrated activity coefficient. All of them were compared depending on the mutational diagnosis and other clinical features and pathological variables. RESULTS Sixty-one patients, and in total 103 thyroid remnants, were included. About 59% of patients were BRAF mutated. The mutation was associated with classic variant (88.5% vs. 11.5%; P=0.0001), desmoplastic reaction (85.7% vs. 14.3%; P=0.002), smaller tumor size (1.5 vs. 2.1 cm; P=0.024), nodal disease (3.3 vs. 1; P=0.001) and advanced stages (76.9% vs. 23%; P=0.014). The BRAFmut group had a lower percentage of 131I uptake at 2 days (0.17% vs. 0.47%; P=0.001) and at 7 days (0.02% vs. 0.1%; P=0.013); and a lower time-integrated activity coefficient (0.05h vs. 0.17 h; P=0.002). In univariate analysis, in addition to the mutation, the histological variant was significant but only for time-integrated activity coefficient (P=0.04). In multivariate analysis, only mutation determined the 2-day uptake (P<0.001) and the time-integrated activity coefficient (P<0.001). CONCLUSIONS The BRAF V600E mutation is associated with lower 131I uptake in thyroid remnants. Furthermore, it is an independent factor that decreases the effect of post-surgical 131I therapy, and therefore, it could be used as a potential tool to optimize the treatment of PTC.
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Affiliation(s)
- Maite Domínguez-Ayala
- Division of Endocrine Surgery, Department of General and Digestive Surgery, OSI Bilbao-Basurto, Basurto University Hospital, Bilbao, Spain -
| | - Pablo Mínguez-Gabiña
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Miguel Paja-Fano
- Department of Endocrinology, OSI Bilbao-Basurto, Basurto University Hospital, Bilbao, Spain
| | | | - Amaia Expósito-Rodríguez
- Division of Endocrine Surgery, Department of General and Digestive Surgery, OSI Bilbao-Basurto, Basurto University Hospital, Bilbao, Spain
| | - Emilia Rodeño-Ortiz de Zarate
- Department of Nuclear Medicine, Gurutzeta-Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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Zhang Q, Xu W. Correlation analysis of I-131 SPECT/CT uptake parameters with the success ablation treatment of thyroid remnant in patients with low-intermediate-risk differentiated thyroid cancer. Nucl Med Commun 2022; 43:1051-1057. [PMID: 35972341 DOI: 10.1097/mnm.0000000000001604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To predict the successful outcome of radioactive iodine-131 (I-131) ablation treatment for differentiated thyroid cancer (DTC) patients using quantitative parameters from therapeutic I-131 SPECT/CT. METHODS This retrospective study enrolled 145 DTC patients (41 males and 104 females) who had radioactive iodine-131 (I-131) (RAI) ablation therapy following thyroidectomy surgery from July 2020 to May 2021. The median age was 47 years (24-65 years). All the patients underwent therapeutic I-131 thyroid SPECT/CT scan after RAI ablation. The I-131 uptake quantitative parameters SUV max , SUV mean %ID and ∆Tg (defined as the Tg level before RAI ablation minus the Tg level after six months) were assessem. Successful ablation treatment was defined as the level of TSH-stimulated Tg≤1 ng/mL and the disappearance of the thyroid bed on a whole-body I-131 scan six months or later after ablation treatment. RESULTS The quantitative parameters from therapeutic I-131 SPECT/CT of the successful ablation (n=130) group with SUV max 7.74 (3.84, 18.78) g/ml, SUV mean 4.02 (2.11, 6.39) g/ml and %ID 2.21% (0.67%, 7.30%) were significantly higher than those of the unsuccessful (n=15) group 0.75 (0.53, 1.28) g/ml, 0.44 (0.29, 0.79) g/ml and 0.16% (0.06%, 1.48%) (Z=-5.87, -5.71 and -4.99, all P < 0.001). SUV max , SUV mean and %ID were positively correlated with ΔTg (all P < 0.001). Receiver operating characteristics curve analysis showed that %ID performed better predict value than either SUV max (AUC=0.914, and 0.874, P=0.009) or SUV mean (AUC= 0.863 P=0.002). SUV max , SUV mean and%ID (OR =1.50, 2.85 and 1.01 all P < 0.001) were all independent predictors of successful RAI ablation. CONCLUSION The quantitative parameters of therapeutic I-131 SPECT/CT were related to the efficacy of ablation treatment, and %ID could predict the successful outcome of ablation treatment for DTC patients.
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Affiliation(s)
- Qian Zhang
- Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Oliveira CV, Camozzato TSC, Dorow PF, Pasqueta J. Analysis of Residence Time, Effective Half-Life, and Internal Dosimetry Before Radioiodine Therapy. J Nucl Med Technol 2022; 50:233-239. [PMID: 36215644 DOI: 10.2967/jnmt.121.263502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Radioiodine therapy has been widely used for ablation of remnant tissue after surgical treatment of differentiated thyroid carcinoma (DTC). Internal dosimetry provides a new approach to choosing the administered activity-an approach that considers the distribution and retention of 131I individually per patient. This study used clinical techniques of internal dosimetry to assess the accumulated activity, internal bone marrow dosimetry, and effective half-life in patients undergoing treatment for DTC. Methods: This was a quantitative, retrospective study analyzing diagnostic documents and images. The internal dosimetry method calculated the dose absorbed by the bone marrow per administered activity of 131I. Calculation of the absorbed dose took into account the accumulated activity, which was obtained through measurements of whole-body images acquired at 4 intervals over 5 d. Results: The median dose absorbed by the bone marrow per administered activity was 0.117 mGy/MBq (range, 0.043-0.152 mGy/MBq). The median whole-body residence time was 22.0 h (range, 12.6-39.4 h). The median effective half-life was 15.6 h (range, 7.6-28.2 h). Conclusion: Internal dosimetry provides information relevant to safe dose limits for DTC radioiodine therapy, especially in advanced cases of the disease for which greater activities may be necessary.
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Affiliation(s)
- Caio Vinicius Oliveira
- Federal Institute of Education, Science, and Technology of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Patricia Fernanda Dorow
- Federal Institute of Education, Science, and Technology of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jéssica Pasqueta
- Federal Institute of Education, Science, and Technology of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Nilsson JN, Siikanen J, Ihre Lundgren C, Ardenfors O. Dosimetric dependencies on target geometry and size in radioiodine therapy for differentiated thyroid cancer. Phys Med 2022; 99:68-72. [DOI: 10.1016/j.ejmp.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/02/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
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Comparison between planar and single-photon computed tomography images for radiation intensity quantification in iodine-131 scintigraphy. Sci Rep 2021; 11:21858. [PMID: 34750482 PMCID: PMC8576011 DOI: 10.1038/s41598-021-01432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate the feasibility of quantifying iodine-131 (131I) accumulation in scintigraphy images and compare planar and single-photon emission computed tomography (SPECT) images to estimate 131I radioactivity in patients receiving radioactive iodine therapy for thyroid cancer. We evaluated 72 sets of planar and SPECT images acquired between February 2017 and December 2018. Simultaneously, we placed a reference 131I capsule next to the patient during image acquisition. We evaluated the correlation between the intensity of the capsule in the images and the capsule dose and estimated the radiation dose at the thyroid bed. The mean capsule dose was 2.14 MBq (range, 0.63–4.31 MBq). The correlation coefficients (p-value) between capsule dose and maximum and mean intensities in both planar and SPECT images were 0.93 (p < 0.01), 0.96 (p < 0.01), 0.60 (p < 0.01), and 0.47 (p < 0.01), respectively. The mean intensities of planar images show the highest correlation coefficients. Based on a regression equation, the average radiation dose in the thyroid bed was 5.9 MBq. In conclusion, planar images reflected the radiation dose more accurately than SPECT images. The regression equation allows to determine the dose in other regions, such as the thyroid bed or sites of distant metastasis.
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Mínguez P, Genollá J, Domínguez M, Expósito A, Santos B, Rodeño E. Dependency of the remnant 131I-NaI biokinetics on the administered activity in patients with differentiated thyroid cancer. Phys Med 2021; 88:45-52. [PMID: 34175746 DOI: 10.1016/j.ejmp.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/15/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To study the dependency of the effective half-life on the administered activity and the correlation between the time-integrated activity and the remnant uptake at 2d and 7d in patients treated for DTC with 1.11 GBq, 3.7 GBq or 5.55 GBq of 131I-NaI. METHODS Ninety-two patients undergoing total thyroidectomy and lymph node removal were included. If cancer had not spread to lymph nodes, patients received 1.11 GBq of 131I-NaI when the lesion maximal diameter was smaller than 4 cm, and 3.7 GBq for bigger sizes. If cancer had spread to lymph nodes patients received 5.55 GBq. There were 30, 49 and 13 patients respectively treated with 1.11 GBq(Group 1), 3.7 GBq(Group 2) and 5.55 GBq(Group 3). Two SPECT/CT scans were performed at 2d and 7d after radioiodine administration for each patient to determine the thyroid remnant activities and effective half-lives of the radioiodine. RESULTS Statistical analysis showed significant differences (p < 0.05) in the effective half-life among patients treated with 1.11 GBq, 3.7 GBq and 5.55 GBq. A high positive correlation (ρ > 0.95) was found between the time-integrated activity and the remnant activity at 2d for the three groups of patients. CONCLUSIONS There were significant differences in the effective half-life of the radioiodine in remnants of patients treated with activities of 1.11 GBq, 3.7 GBq or 5.55 GBq. The high positive linear correlation found between the time-integrated activity and the remnant activity at 2d for the three groups of patients indicate that the time-integrated activity could be estimated from one time-point.
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Affiliation(s)
- Pablo Mínguez
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain; Faculty of Engineering, Department of Applied Physics I, UPV/EHU, Bilbao, Spain.
| | - José Genollá
- Department of Nuclear Medicine, Gurutzeta-Cruces University Hospital/Biocruces BizkaiaHealth Research Institute, Barakaldo, Spain.
| | - Maite Domínguez
- Department of General and Digestive Surgery, Basurto University Hospital, Bilbao, Spain.
| | - Amaia Expósito
- Department of General and Digestive Surgery, Division of Endocrine Surgery, Basurto University Hospital, Bilbao, Spain.
| | - Borja Santos
- Scientific Coordination Unit, Biocruces Bizkaia Health Research Institute, Gurutzeta-Cruces University Hospital, Barakaldo, Spain.
| | - Emilia Rodeño
- Department of Nuclear Medicine, Gurutzeta-Cruces University Hospital/Biocruces BizkaiaHealth Research Institute, Barakaldo, Spain.
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Dotinga M, Vriens D, van Velden F, Heijmen L, Nagarajah J, Hicks R, Kapiteijn E, de Geus-Oei LF. Managing radioiodine refractory thyroid cancer: the role of dosimetry and redifferentiation on subsequent I-131 therapy. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 64:250-264. [PMID: 32744039 DOI: 10.23736/s1824-4785.20.03264-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Poor responses to iodine-131 (I-131) therapy can relate to either low iodine uptake and retention in thyroid cancer cells or to increased radioresistance. Both mechanisms are currently termed radioactive iodine (RAI)-refractory (RAI-R) thyroid cancer but the first reflects unsuitability for I-131 therapy that can be evaluated in advance of treatment, whereas the other can only be identified post hoc. Management of both represents a considerable challenge in clinical practice as failure of I-131 therapy, the most effective treatment of metastatic thyroid cancer, is associated with a poor overall prognosis. The development of targeted therapies has shown substantial promise in the treatment of RAI-R thyroid cancer in progressive patients. Recent studies show that selective tyrosine kinase inhibitors (TKIs) targeting B-type rapidly accelerated fibrosarcoma kinase (BRAF) and mitogen-activated protein kinase (MEK) can be used as redifferentiation agents to re-induce RAI uptake, thereby (re)enabling I-131 therapy. The use of dosimetry prior- and post-TKI treatment can assist in quantifying RAI uptake and improve identification of patients that will benefit from I-131 therapy. It also potentially offers the prospect of calculating individualized therapeutic administered activities to enhance efficacy and limit toxicity. In this review, we present an overview of the regulation of RAI uptake and clinically investigated redifferentiation agents, both reimbursed and in experimental setting, that induce renewed RAI uptake. We describe the role of dosimetry in redifferentiation and subsequent I-131 therapy in RAI-R thyroid cancer, explain different dosimetry approaches and discuss limitations and considerations in the field.
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Affiliation(s)
- Maaike Dotinga
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands -
| | - Dennis Vriens
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Floris van Velden
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Linda Heijmen
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - James Nagarajah
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - Rodney Hicks
- Department of Molecular Imaging, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
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Mínguez P, Rodeño E, Genollá J, Domínguez M, Expósito A, Sjögreen Gleisner K. Analysis of activity uptake, effective half-life and time-integrated activity for low- and high-risk papillary thyroid cancer patients treated with 1.11 GBq and 3.7 GBq of 131I-NaI respectively. Phys Med 2019; 65:143-149. [DOI: 10.1016/j.ejmp.2019.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022] Open
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Two decades of SPECT/CT - the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46:1990-2012. [PMID: 31273437 PMCID: PMC6667427 DOI: 10.1007/s00259-019-04404-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality two decades ago. The main advantage of SPECT/CT is the increased specificity achieved through a more precise localization and characterization of functional findings. The improved diagnostic accuracy is also associated with greater diagnostic confidence and better inter-specialty communication. METHODS This review presents a critical assessment of the relevant literature published so far on the role of SPECT/CT in a variety of clinical conditions. It also includes an update on the established evidence demonstrating both the advantages and limitations of this modality. CONCLUSIONS For the majority of applications, SPECT/CT should be a routine imaging technique, fully integrated into the clinical decision-making process, including oncology, endocrinology, orthopaedics, paediatrics, and cardiology. Large-scale prospective studies are lacking, however, on the use of SPECT/CT in certain clinical domains such as neurology and lung disorders. The review also presents data on the complementary role of SPECT/CT with other imaging modalities and a comparative analysis, where available.
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Gear JI, Cox MG, Gustafsson J, Gleisner KS, Murray I, Glatting G, Konijnenberg M, Flux GD. EANM practical guidance on uncertainty analysis for molecular radiotherapy absorbed dose calculations. Eur J Nucl Med Mol Imaging 2018; 45:2456-2474. [PMID: 30218316 PMCID: PMC6208822 DOI: 10.1007/s00259-018-4136-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
Abstract
A framework is proposed for modelling the uncertainty in the measurement processes constituting the dosimetry chain that are involved in internal absorbed dose calculations. The starting point is the basic model for absorbed dose in a site of interest as the product of the cumulated activity and a dose factor. In turn, the cumulated activity is given by the area under a time-activity curve derived from a time sequence of activity values. Each activity value is obtained in terms of a count rate, a calibration factor and a recovery coefficient (a correction for partial volume effects). The method to determine the recovery coefficient and the dose factor, both of which are dependent on the size of the volume of interest (VOI), are described. Consideration is given to propagating estimates of the quantities concerned and their associated uncertainties through the dosimetry chain to obtain an estimate of mean absorbed dose in the VOI and its associated uncertainty. This approach is demonstrated in a clinical example.
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Affiliation(s)
- Jonathan I Gear
- The Royal Marsden NHS Foundation Trust & Institute of Cancer Research, Downs Road, Sutton, SM2 5PT, UK.
| | - Maurice G Cox
- National Physical Laboratory, Teddington, TW11 0LW, UK
| | - Johan Gustafsson
- Department of Medical Radiation Physics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Iain Murray
- The Royal Marsden NHS Foundation Trust & Institute of Cancer Research, Downs Road, Sutton, SM2 5PT, UK
| | - Gerhard Glatting
- Medical Radiation Physics, Department of Nuclear Medicine, Ulm University, Ulm, Germany
| | | | - Glenn D Flux
- The Royal Marsden NHS Foundation Trust & Institute of Cancer Research, Downs Road, Sutton, SM2 5PT, UK
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Domínguez Ayala M, Expósito Rodríguez A, Bilbao González A, Mínguez Gabiña P, Gutiérrez Rodríguez T, Rodeño Ortiz de Zarate E, García Carrillo M, Barrios Treviño B. BRAF V600E mutation in papillary thyroid cancer and its effect on postoperative radioiodine ( 131I) therapy: Should we modify our therapeutic strategy? Cir Esp 2018; 96:276-282. [PMID: 29567362 DOI: 10.1016/j.ciresp.2018.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The BRAF V600E mutation in papillary thyroid cancer (PTC) has been associated with resistance to 131I. Our aim was to quantify the response to 131I after surgery in patients who had the mutation (BRAF+) and those who did not have the mutated gene (BRAF-). METHOD A prospective cohort study was designed, from September 2015 to February 2016, which included patients with PTC receiving therapy after surgical treatment. Variables were described for age, gender, histology, tumor stage, thyroglobulin values before, 48h after and 6months after 131I; absorbed dose and % activity on days 2 and 7 and elimination time. RESULTS 41 patients giving in total 67 thyroid remnants were included. 61% were BRAF+. In stagesiii and iv, 80% were BRAF+. In lateral resection, 100% were BRAF+. The number of nodes was higher in BRAF+: 3.4 vs 1.2 (P=.01). The classic variant was predominant in BRAF+ (91.7% vs 8.3%, P=.03). 85.7% vs 14.3% of BRAF+ had desmoplastic reaction (P=.02). The BRAF+ had a lower absorbed dose than the administered activity (5.4Gy/MBq vs 20Gy/MBq, P=.02); lower% activity with respect to the unit of mass at 2 (0.046%/g vs 0.103%/g, P=.02) and at 7days (0.006%/gr vs 0.034%/gr, P=.04) CONCLUSIONS: The mutation of the BRAF V600E gene is related with greater resistance to postoperative treatment with 131I since the onset of the disease.
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Affiliation(s)
- Maite Domínguez Ayala
- Departamento de Cirugía General y Digestiva, Hospital Universitario Basurto, Bilbao, España.
| | | | | | - Pablo Mínguez Gabiña
- Departamento de Medicina Física, Hospital Universitario Gurutzeta-Cruces, Barakaldo, Bizkaia, España
| | | | | | | | - Borja Barrios Treviño
- Departamento de Cirugía General y Digestiva, Hospital Universitario Basurto, Bilbao, España
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Sjögreen Gleisner K, Spezi E, Solny P, Gabina PM, Cicone F, Stokke C, Chiesa C, Paphiti M, Brans B, Sandström M, Tipping J, Konijnenberg M, Flux G. Variations in the practice of molecular radiotherapy and implementation of dosimetry: results from a European survey. EJNMMI Phys 2017; 4:28. [PMID: 29199391 PMCID: PMC5712507 DOI: 10.1186/s40658-017-0193-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, the implementation of dosimetry in molecular radiotherapy (MRT) is not well investigated, and in view of the Council Directive (2013/59/Euratom), there is a need to understand the current availability of dosimetry-based MRT in clinical practice and research studies. The aim of this study was to assess the current practice of MRT and dosimetry across European countries. METHODS An electronic questionnaire was distributed to European countries. This addressed 18 explicitly considered therapies, and for each therapy, a similar set of questions were included. Questions covered the number of patients and treatments during 2015, involvement of medical specialties and medical physicists, implementation of absorbed dose planning, post-therapy imaging and dosimetry, and the basis of therapy prescription. RESULTS Responses were obtained from 26 countries and 208 hospitals, administering in total 42,853 treatments. The most common therapies were 131I-NaI for benign thyroid diseases and thyroid ablation of adults. The involvement of a medical physicist (mean over all 18 therapies) was reported to be either minority or never by 32% of the responders. The percentage of responders that reported that dosimetry was included on an always/majority basis differed between the therapies and showed a median value of 36%. The highest percentages were obtained for 177Lu-PSMA therapy (100%), 90Y microspheres of glass (84%) and resin (82%), 131I-mIBG for neuroblastoma (59%), and 131I-NaI for benign thyroid diseases (54%). The majority of therapies were prescribed based on fixed-activity protocols. The highest number of absorbed-dose based prescriptions were reported for 90Y microsphere treatments in the liver (64% and 96% of responses for resin and glass, respectively), 131I-NaI treatment of benign thyroid diseases (38% of responses), and for 131I-mIBG treatment of neuroblastoma (18% of responses). CONCLUSIONS There is a wide variation in MRT practice across Europe and for different therapies, including the extent of medical-physicist involvement and the implementation of dosimetry-guided treatments.
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Affiliation(s)
| | | | - Pavel Solny
- Department of Nuclear Medicine and Endocrinology, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pablo Minguez Gabina
- Department of Medical Physics and Radiation Protection, Gurutzeta/Cruces University Hospital, Barakaldo, Spain
| | - Francesco Cicone
- Nuclear Medicine, Sant’Andrea Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Carlo Chiesa
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria Paphiti
- Department of Medical Physics, Pammakaristos Hospital, Athens, Greece
| | - Boudewijn Brans
- Department of Nuclear Medicine and PET Center, University Hospital, Ghent, Belgium
| | - Mattias Sandström
- Department of Surgical Sciences, Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Jill Tipping
- The Christie NHS Foundation Trust, Nuclear Medicine, Manchester, UK
| | - Mark Konijnenberg
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
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14
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Flux GD, Sjogreen Gleisner K, Chiesa C, Lassmann M, Chouin N, Gear J, Bardiès M, Walrand S, Bacher K, Eberlein U, Ljungberg M, Strigari L, Visser E, Konijnenberg MW. From fixed activities to personalized treatments in radionuclide therapy: lost in translation? Eur J Nucl Med Mol Imaging 2017; 45:152-154. [PMID: 29080096 PMCID: PMC5700228 DOI: 10.1007/s00259-017-3859-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 11/02/2022]
Affiliation(s)
- G D Flux
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
| | | | - C Chiesa
- Nuclear Medicine, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - N Chouin
- Nantes-Angers Cancer Research Center CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001, Nantes, France.,Oniris, AMaROC Unit, Nantes, France
| | - J Gear
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - M Bardiès
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037 INSERM Université Paul Sabatier, Toulouse, France
| | - S Walrand
- Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain, Brussels, Belgium
| | - K Bacher
- Department of Basic Medical Sciences, Division of Medical Physics, Ghent University, Ghent, Belgium
| | - U Eberlein
- Nuclear Medicine, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M Ljungberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - L Strigari
- Laboratory of Medical Physics and Expert Systems, National Cancer Institute Regina Elena, Rome, Italy
| | - E Visser
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre (RadboudUMC), Nijmegen, The Netherlands
| | - M W Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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15
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Newbold KL, Flux G, Wadsley J. Radioiodine for High Risk and Radioiodine Refractory Thyroid Cancer: Current Concepts in Management. Clin Oncol (R Coll Radiol) 2017; 29:307-309. [PMID: 28139379 DOI: 10.1016/j.clon.2016.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/13/2016] [Indexed: 11/15/2022]
Abstract
The management of early stage differentiated thyroid cancer (DTC) with low risk of recurrence has been the subject of much interest and investigation in the recent years. Locally advanced DTC and patients with a high risk of recurrent disease however needs further investigation. This short review will look at what constitutes high risk thyroid cancer, the definition of radioiodine refractory disease, the current management and areas of debate within this clinical setting.
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Affiliation(s)
- K L Newbold
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
| | - G Flux
- Department of Medical Physics, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - J Wadsley
- Department of Clinical Oncology, Weston Park Hospital, Sheffield Teaching Hospitals Trust, Sheffield, UK
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