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Boschi S, Castellucci P, Nanni C. Theragnostic: radiopharmaceuticals and nuclear medicine as viewed through Hegel's eyes. Eur J Nucl Med Mol Imaging 2024; 51:942-946. [PMID: 38114617 DOI: 10.1007/s00259-023-06570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Stefano Boschi
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy.
| | - Paolo Castellucci
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
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2
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Medici F, Strolin S, Castellucci P, Cilla S, Laghi V, Galietta E, Vadalà M, Strigari L, Morganti AG, Cammelli S. Complete metabolic response after Partially Ablative Radiotherapy (PAR) for bulky retroperitoneal liposarcoma: A case report. Radiol Case Rep 2024; 19:305-309. [PMID: 38028304 PMCID: PMC10656220 DOI: 10.1016/j.radcr.2023.10.024] [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: 09/26/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
In the management of symptomatic inoperable retroperitoneal sarcomas (RPS), palliative radiotherapy (RT) is a potential treatment option. However, the efficacy of low doses used in palliative RT is limited in these radioresistant tumors. Therefore, exploring dose escalation strategies targeting specific regions of the tumor may enhance the therapeutic effect of RT in relieving or preventing symptoms. In this case report, we present the case of an 87-year-old patient with rapidly growing undifferentiated liposarcoma in the retroperitoneum, where surgical and systemic therapies were ruled out due to age and comorbidities. RT was administered using volumetric modulated arc therapy, delivering 20 Gy in 4 fractions twice daily to the macroscopic tumor and 40 Gy in 4 fractions twice daily (simultaneous integrated boost) to the central part of the tumor (Gross Tumor Volume minus 2 cm). An 18F-FDG-PET-CT scan performed after RT demonstrated a complete metabolic response throughout the entire tumor mass. Although the patient eventually succumbed to metastatic spread to the bone, liver, and lung after 9 months, no local disease progression or pain/obstructive symptoms were observed. This case highlights the technical and clinical feasibility of delivering ablative doses of RT to the central region of the tumor and suggests the potential for achieving a complete metabolic response and durable tumor control.
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Affiliation(s)
- Federica Medici
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Strolin
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Viola Laghi
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Erika Galietta
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Cammelli
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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3
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Castellucci P, Mei R, Farolfi A, Nanni C, Fanti S. Potential Clinical Applications of Dedicated Prostate Positron Emission Tomography. PET Clin 2024; 19:119-124. [PMID: 37777381 DOI: 10.1016/j.cpet.2023.09.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
The diagnosis of prostate cancer (PCa) is usually based on transrectal or transperineal biopsies (from 12 to 24 samples) in most cases after the performance of a dedicated MRI and/or transrectal ultrasound. A small-dedicated PET scanner could improve spatial resolution and increase sensitivity, allowing a precise detection and location of the PCa foci, thus allowing an image-guided biopsy. In this short review, we will focus our attention on the potential application of a dedicated prostate PET scanner and on the prototype that has been already assembled for this purpose.
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Affiliation(s)
- Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Riccardo Mei
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Vetrone L, Fortunati E, Castellucci P, Fanti S. Future Imaging of Prostate Cancer: Do We Need More Than PSMA PET/CT? Semin Nucl Med 2024; 54:150-162. [PMID: 37394289 DOI: 10.1053/j.semnuclmed.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Abstract
In the setting of prostate cancer (PCa), many different imaging modalities are available to correctly assess staging, restaging, treatment response and radio-ligand therapy recruitment. The introduction of fluoride or gallium-labelled prostate specific membrane antigen (PSMA) made a revolution in PCa management, also due to its possible theragnostic use. Nowadays PSMA-PET/CT is a fundamental tool for staging and restaging PCa. This review discusses the latest findings in PSMA imaging in PCa patients and the impact of PSMA imaging on the patients' management in primary staging, biochemical recurrence and in advanced prostate cancer, always keeping in mind the important theragnostic role of PSMA. This review tries also to assess the current role of other radiopharmaceuticals as Choline, FACBC or other radiotracers like gastrin-releasing peptide receptor targeting tracers and FAPI in different PCa settings.
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Affiliation(s)
- Luigia Vetrone
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emilia Fortunati
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy; Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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5
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Gottardi F, Baccelli F, Leardini D, Di Battista A, Castellucci P, D'Amico D, Serravalle S, Bertuccio SN, Messelodi D, Prete A, Masetti R. Successful treatment of a chemotherapy-resistant t(17;19) paediatric ALL with a combination of inotuzumab, venetoclax and navitoclax. Br J Haematol 2023; 202:e39-e42. [PMID: 37350036 DOI: 10.1111/bjh.18936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Francesca Gottardi
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Baccelli
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Leardini
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonia Di Battista
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Domenico D'Amico
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Serravalle
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Nicola Bertuccio
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Daria Messelodi
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Arcangelo Prete
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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6
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Mei R, Kessler L, Pabst KM, Weber M, Schimdkonz C, Rischpler C, Zacho HD, Hope T, Schwarzenböck SM, Allen-Auerbach M, Emmett L, Ferdinandus J, Unterrainer M, Schaarschmidt BM, Umutlu L, Farolfi A, Castellucci P, Nanni C, Telo S, Fanti S, Herrmann K, Fendler WP. 68Ga-FAPI PET/CT Interobserver Agreement on Tumor Assessment: An International Multicenter Prospective Study. J Nucl Med 2023:jnumed.122.265245. [PMID: 37230530 DOI: 10.2967/jnumed.122.265245] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/21/2023] [Indexed: 05/27/2023] Open
Abstract
68Ga-fibroblast activation protein inhibitors (FAPIs) are promising radiotracers for cancer imaging, with emerging data in the recent years. Nonetheless, the interobserver agreement on 68Ga-FAPI PET/CT study interpretations in cancer patients remains poorly understood. Methods: 68Ga-FAPI PET/CT was performed on 50 patients with various tumor entities (sarcoma [n = 10], colorectal cancer [n = 10], pancreatic adenocarcinoma [n = 10], genitourinary cancer [n = 10], and other types of cancer [n = 10]). Fifteen masked observers reviewed and interpreted the images using a standardized approach for local, local nodal, and metastatic involvement. Observers were grouped by experience as having a low (<30 prior 68Ga-FAPI PET/CT studies; n = 5), intermediate (30-300 studies; n = 5), or high level of experience (>300 studies; n = 5). Two independent readers with a high level of experience and unmasked to clinical information, histopathology, tumor markers, and follow-up imaging (CT/MRI or PET/CT) served as the standard of reference (SOR). Observer groups were compared by overall agreement (percentage of patients matching SOR) and Fleiss κ with mean and corresponding 95% CI. We defined acceptable agreement as a κ value of at least 0.6 (substantial or higher) and acceptable accuracy as at least 80%. Results: Highly experienced observers agreed substantially on all categories (primary tumor: κ = 0.71; 95% CI, 0.71-0.71; local nodal involvement: κ = 0.62; 95% CI, 0.61-0.62; distant metastasis: κ = 0.75; 95% CI, 0.75-0.75), whereas observers with intermediate experience showed substantial agreement on primary tumor (κ = 0.73; 95% CI, 0.73-0.73) and distant metastasis (κ = 0.65; 95% CI, 0.65-0.65) but moderate agreement on local nodal stages (κ = 0.55; 95% CI, 0.55-0.55). Observers with low experience had moderate agreement on all categories (primary tumor: κ = 0.57; 95% CI, 0.57-0.58; local nodal involvement: κ = 0.51; 95% CI, 0.51-0.52; distant metastasis: κ = 0.54; 95% CI, 0.53-0.54). Compared with SOR, the accuracy for readers with high, intermediate, and low experience was 85%, 83%, and 78%, respectively. In summary, only highly experienced readers showed substantial agreement and a diagnostic accuracy of at least 80% in all categories. Conclusion: The interpretation of 68Ga-FAPI PET/CT for cancer imaging had substantial reproducibility and accuracy among highly experienced observers only, especially for local nodal and metastatic assessments. Therefore, for accurate interpretation of different tumor entities and pitfalls, we recommend training or experience with at least 300 representative scans for future clinical readers.
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Affiliation(s)
- Riccardo Mei
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany;
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | | | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | | | - Thomas Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | | | - Martin Allen-Auerbach
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California
- Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, and Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Justin Ferdinandus
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Marcus Unterrainer
- Department of Radiology, University Hospital LMU Munich, Munich, Germany; and
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andrea Farolfi
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvi Telo
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, and German Cancer Research Center, Essen, Germany
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Serani F, Fendler WP, Castellucci P, Berliner C, Barbato F, Herrmann K, Farolfi A, Fanti S. A Retrospective Multicenter Analysis of the Incidence of Bone-Only Disease at PSMA PET/CT in Castration Resistant Prostate Cancer Patients. Cancers (Basel) 2023; 15:cancers15082208. [PMID: 37190136 DOI: 10.3390/cancers15082208] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
PSMA PET/CT has unprecedented accuracy for localization of initial or recurrent prostate cancer (PC), which can be applied in a metastasis-directed therapy approach. PSMA PET/CT (PET) also has a role in the selection of patients for metastasis-directed therapy or radioligand therapy and therapy assessment in CRPC patients. The purpose of this multicenter retrospective study was to determine the incidence of bone-only metastasis in CRPC patients who underwent PSMA PET/CT for restaging, as well as identifying potential predictors of bone-only PET positivity. The study analyzed data from 179 patients from two centers in Essen and Bologna. Results showed that 20.1% of the patients had PSMA uptake only in the bone, with the most frequent lesions located in the vertebrae, ribs, and hip bone. Half half of the patients showed oligo disease in bone and may benefit from a bone-metastasis-directed therapy. Initial positive nodal status and solitary ADT were shown to be negative predictors of osseous metastasis. The role of PSMA PET/TC in this patient population needs to be further explored in terms of its role in the evaluation and adoption of bone-specific therapies.
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Affiliation(s)
- Francesca Serani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Paolo Castellucci
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Christoph Berliner
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Francesco Barbato
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Andrea Farolfi
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Fanti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Nuclear Medicine Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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8
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Bianchi L, Ceci F, Balestrazzi E, Costa F, Droghetti M, Piazza P, Pissavini A, Presutti M, Farolfi A, Mei R, Castellucci P, Gandaglia G, Larcher A, Robesti D, Mottrie A, Briganti A, Morganti AG, Fanti S, Montorsi F, Schiavina R, Brunocilla E. PSMA-PET Guided Treatment in Prostate Cancer Patients with Oligorecurrent Progression after Previous Salvage Treatment. Cancers (Basel) 2023; 15:cancers15072027. [PMID: 37046687 PMCID: PMC10093227 DOI: 10.3390/cancers15072027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is used to select recurrent prostate cancer (PCa) patients for metastases-directed therapy (MDT). We aimed to evaluate the oncologic outcomes of second-line PSMA-guided MDT in oligo-recurrent PCa patients. Methods: we performed a retrospective analysis of 113 recurrent PCa after previous radical prostatectomy and salvage therapies with oligorecurrent disease at PSMA-PET (≤3 lesions in N1/M1a-b) in three high-volume European centres. Patients underwent second-line salvage treatments: MDT targeted to PSMA (including surgery and/or radiotherapy), and the conventional approach (observation or Androgen Deprivation Therapy [ADT]). Patients were stratified according to treatments (MDT vs. conventional approach). Patients who underwent MDT were stratified according to stage in PSMA-PET (N1 vs. M1a-b). The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were Metastases-free survival (MFS) and Castration Resistant PCa free survival (CRPC-FS). Kaplan-Meier analyses assessed PFS, MFS and CRPC-FS. Multivariable Cox regression models identified predictors of progression and metastatic disease. Results: Overall, 91 (80%) and 22 (20%) patients were treated with MDT and the conventional approach, respectively. The median follow-up after PSMA-PET was 31 months. Patients who underwent MDT had a similar PFS compared to the conventional approach (p = 0.3). Individuals referred to MDT had significantly higher MFS and CRPC-FS compared to those who were treated with the conventional approach (73.5% and 94.7% vs. 30.5% and 79.5%; all p ≤ 0.001). In patients undergoing MDT, no significant differences were found for PFS and MFS according to N1 vs. M1a-b disease, while CRPC-FS estimates were significantly higher in patients with N1 vs. M1a-b (100% vs. 86.1%; p = 0.02). At multivariable analyses, age (HR = 0.96) and ADT during second line salvage treatment (HR = 0.5) were independent predictors of PFS; MDT (HR 0.27) was the only independent predictor of MFS (all p ≤ 0.04) Conclusion: Patients who underwent second-line PSMA-guided MDT experienced higher MFS and CRPC-FS compared to men who received conventional management.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40127 Bologna, Italy
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Correspondence:
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesco Costa
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandro Pissavini
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Massimiliano Presutti
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Farolfi
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Riccardo Mei
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Daniele Robesti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, 9300 Aalst, Belgium
- ORSI Academy, 9090 Melle, Belgium
| | - Alberto Briganti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology Division, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Fanti
- Department of Medical and Surgical Sciences, University of Bologna, 40127 Bologna, Italy
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40127 Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40127 Bologna, Italy
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9
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Zagni F, Vichi S, Paolani G, Santoro M, Gala GD, Strolin S, Castellucci P, Vetrone L, Fanti S, Morganti AG, Strigari L. A novel tool for predicting the dose distribution of non-sealed 188 Re (Rhenium) resin in non-melanoma skin cancers (NMSC) patients. Med Phys 2023. [PMID: 36919341 DOI: 10.1002/mp.16346] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND High-dose rate brachytherapy using a non-sealed 188 Rhenium resin (188 Re) is a recently approved treatment option for Non-Melanoma Skin Cancer (NMSC). The treatment goal is to deliver a personalized absorbed dose to the deepest point of neoplastic infiltration corresponding to the minimal target dose. The treatment consists of the application of a 188 Re-based resin over a plastic foil placed on the target skin surface. However, there is no treatment planning tool to assess the 188 Re activity needed for a personalized treatment. PURPOSE The paper aims to present a novel Monte Carlo (MC)-based tool for 188 Re-based resin activity and dose calculation, experimentally validated using Gafchromic EBT3 films. METHODS MC simulations were carried out using FLUKA modeling density and composition of 188 Re resin. The MC-based Look Up Table (LUT) was incorporated in an ad hoc developed tool. The proposed tool allows the personalized calculation of treatment parameters (i.e., acti×vity to be dispensed, the treatment duration and dose volume histograms), according to the target dimension. The proposed tool was compared using Bland-Altman analysis to the previous calculation approaches conducted using VARSKIN in a retrospective cohort of 76 patients. The tool was validated in ad hoc experimental set ups using a stack of calibrated Gafchromic EBT3 films covered by a plastic film and exposed using a homogenous activity distribution of 188 Re eluate and a heterogeneous activity distribution of 188 Re resin mimic the patient treatment. RESULTS The agreement between the proposed tool and VARSKIN was evaluated on the investigated cohort with median range of Target Area, Target Depth and Treatment Time equal to 4.8 [1.0-60.1] cm2 , 1.1 [0.2-3.0] mm and 70 [21-285] min, with a median range of Target Dose (Gy) of 23.5 [10-54.9]. The calculated minimal target doses, ranged from 1% to 10% for intermediate target depths (1.2±0.7 mm), while showing significant differences in the estimation of superficial (maximal) target doses. The agreement between MC calculation and measurements at different plans in a stack of Gafchromic EBT3 films was within 10% for both the homogenous and heterogeneous activity distribution of 188 Re. Worst agreements were observed for absorbed doses lower than 0.3 Gy. CONCLUSIONS Our results support the implementation of our MC-based tool in the practical routine for calculating the 188 Re resin activity and treatment parameters necessary for obtaining the prescribed minimal target dose. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Federico Zagni
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sara Vichi
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Paolani
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Medical Physics Specialization School, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Miriam Santoro
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Medical Physics Specialization School, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giuseppe Della Gala
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Strolin
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigia Vetrone
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.,Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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10
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Vetrone L, Mei R, Bianchi L, Giunchi F, Farolfi A, Castellucci P, Droghetti M, Presutti M, Degiovanni A, Schiavina R, Brunocilla E, D’Errico A, Fanti S. Histology and PSMA Expression on Immunohistochemistry in High-Risk Prostate Cancer Patients: Comparison with 68Ga-PSMA PET/CT Features in Primary Staging. Cancers (Basel) 2023; 15:cancers15061716. [PMID: 36980602 PMCID: PMC10046634 DOI: 10.3390/cancers15061716] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
PSMA-PET/CT is a suitable replacement for conventional imaging in the primary staging of PCa. The aim of this retrospective study was to assess the correlation between parameters discovered by PSMA PET/CT in primary staging and either prostate histopathology (pT) findings or PSMA-IHC expression in a cohort of biopsy-proven high-risk PCa candidates for surgery. Clinical information (age, iPSA-value, and grading group) and PSMA-PET/CT parameters (SUVmax, PSMA tumor volume [PSMA-TV], and total lesion [PSMA-TL]) were compared with pT (including histologic pattern, Gleason grade, and lymphovascular invasion [LVI]) and PSMA-IHC features, including visual quantification (VS) with a four-tiered score (0 = negative, 1+ = weak, 2+ = moderate, 3+ = strong), growth pattern (infiltrative vs expansive), and visual pattern (cytoplasmic vs membranous). In total, 44 patients were enrolled, with a median age of 67 (IQR 57-77); the median iPSA was 9.4 ng/dL (IQR 12.5-6.0). One patient (3%) was grading group (GG) 3, 27/44 (61%) were GG4, and 16/44 (36%) were GG5. PSMA-PET/CT detection rate for the presence of primary prostate cancer was 100%. Fused/poorly formed Gleason grade 4 features were predominant (22/44–50%); a cribriform pattern was present in 18/44 (41%) and acinar in 4/44 (9%). We found that lower PSMA-TVs were mostly related to acinar, while higher PSMA-TVs correlated with a higher probability to have a cribriform pattern (p-value 0.04). LVI was present in 21/44(48%) patients. We found that higher PSMA-TV and PSMA-TL are predictive of LVI p-value 0.002 and p-value 0.01, respectively. There was no correlation between PET-parameters and perineural invasion (PNI), probably because this was present in almost all the patients. Moreover, patients with high PSMA-TL values displayed the highest PSMA-IHC expression (VS3+) with a membranous pattern. In conclusion, PSMA-TV and PSMA-TL are predictors of a cribriform pattern and LVI. These conditions are mostly related to higher aggressiveness and worse outcomes.
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Affiliation(s)
- Luigia Vetrone
- Nuclear Medicine, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
- Correspondence: (L.V.); (F.G.)
| | - Riccardo Mei
- Nuclear Medicine, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Francesca Giunchi
- Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
- Correspondence: (L.V.); (F.G.)
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Massimiliano Presutti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Alessio Degiovanni
- Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Antonietta D’Errico
- Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant’Orsola, 40138 Bologna, Italy
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11
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Vetrone L, Cuzzani G, Mei R, Zanoni L, Bertaccini A, Bianchi L, Castellucci P, Gaudiano C, Cappelli A, Giunchi F, Fanti S. Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge. Front Oncol 2023; 13:1101221. [PMID: 36824128 PMCID: PMC9941543 DOI: 10.3389/fonc.2023.1101221] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023] Open
Abstract
This is a case of [68 Ga]Ga-Prostate-specific membrane antigen (PSMA)-11 PET/CT in a 73-years old patient presenting high Prostate Specific Antigen (PSA) levels despite both multi-parametric magnetic resonance imaging (mpMRI) and 12-core saturation biopsy negative for prostate cancer (Pca). This is a highly interesting case because, despite the advanced metastatic spread at initial presentation as showed by [68Ga]Ga-PSMA-PET/CT, the primary Pca was detected by none of the diagnostic techniques (12 random sample biopsy, mpMRI, PSMA PET/CT). However, [68Ga]Ga-PSMA-PET/CT showed a suspicious axillary lesion suitable for biopsy, which finally resulted as Pca metastasis. This case report is therefore a brilliant example of how [68Ga]Ga-PSMA-PET/CT optimized patient's management.
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Affiliation(s)
- Luigia Vetrone
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Cuzzani
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Riccardo Mei
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy,*Correspondence: Riccardo Mei,
| | - Lucia Zanoni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesca Giunchi
- Pathology Unit, IRRCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy,Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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12
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Bianchi L, Castellucci P, Farolfi A, Droghetti M, Artigas C, Leite J, Corona P, Shagera QA, Moreira R, González C, Queiroz M, de Galiza Barbosa F, Schiavina R, Deandreis D, Fanti S, Ceci F. Multicenter External Validation of a Nomogram for Predicting Positive Prostate-specific Membrane Antigen/Positron Emission Tomography Scan in Patients with Prostate Cancer Recurrence. Eur Urol Oncol 2023; 6:41-48. [PMID: 34933814 DOI: 10.1016/j.euo.2021.12.002] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/14/2021] [Accepted: 12/03/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND A nomogram has recently been developed to predict 68Ga-labeled prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET)/computed tomography (PSMA-PET) results in recurrent prostate cancer (PCa) patients. OBJECTIVE To perform external validation of the original nomogram in a multicentric setting. DESIGN, SETTING, AND PARTICIPANTS A total of 1639 patients who underwent PSMA-PET for prostate-specific antigen (PSA) relapse after radical therapy were retrospectively included from six high-volume PET centers. The external cohort was stratified according to clinical setting categories: group 1: first-time biochemical recurrence (n = 774); group 2: PSA relapse after salvage therapy (n = 499); group-3: biochemical persistence after radical prostatectomy (n = 210); and group-4: advanced-stage PCa before second-line systemic therapies (n = 124). INTERVENTION PSMA-PET in recurrent PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PSMA-PET detection rate was assessed in the overall population and in each subgroup. A multivariable logistic regression model was produced to evaluate the predictors of a positive scan. The performance characteristics of the model were assessed by quantifying the predictive accuracy (PA) according to model calibration. The Youden's index was used to find the best nomogram's cutoff. Decision curve analysis (DCA) was implemented to quantify the nomogram's clinical net benefit. RESULTS AND LIMITATIONS In the external cohort, the overall detection rate was 53.8% versus 51.2% in the original population. At multivariate analysis, International Society of Urological Pathology grade group, PSA, PSA doubling time, and clinical setting were independent predictors of a positive scan (all p ≤ 0.02). The PA of the nomogram was identical to the original model (82.0%); the model showed an optimal calibration curve. The best nomogram's cutoff was 55%. In the DCA, the nomogram revealed clinical net benefit when the threshold nomogram probabilities were ≥20%. The retrospective design is a major limitation. CONCLUSIONS The original nomogram exhibited excellent characteristics on external validation. The incidence of a false negative scan can be reduced if PSMA-PET is performed when the predicted probability is ≥20%. PATIENT SUMMARY A nomogram has been developed to predict prostate-specific membrane antigen/positron emission tomography (PSMA-PET) results for recurrent prostate cancer (PCa). The nomogram represents an easy tool in the decision-making process of recurrent PCa.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Farolfi
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlos Artigas
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jose Leite
- PET/CT Center, DASA - Diagnósticos da Améric, Rio de Janeiro, Brazil
| | - Paola Corona
- Fundación Centro Diagnóstico Nuclear (FCDN), Buenos Aires, Argentina
| | - Qaid Ahmed Shagera
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Renata Moreira
- PET/CT Center, DASA - Diagnósticos da Améric, Rio de Janeiro, Brazil
| | | | - Marcelo Queiroz
- Department of Radiology, Hospital Sírio-Libanês, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Desiree Deandreis
- Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefano Fanti
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Ceci
- Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology IRCCS, Milan, Italy
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13
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Droghetti M, Bianchi L, Balestrazzi E, Ceci F, Costa F, Pissavini A, Presutti M, Scarlatti R, Farolfi A, Mei R, Castellucci P, Puliatti S, Gandaglia G, Larcher A, Mottrie A, Briganti A, Morganti A, Fanti S, Montorsi F, Schiavina R, Brunocilla E. PSMA-PET for recurrent prostate cancer and guidance of salvage treatments: Is the sooner always the better? (shoot blind or sharpshooting?). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00312-3] [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: 02/12/2023]
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14
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Bianchi L, Pissavini A, Droghetti M, Pugliese M, Massimiliano P, Riccardo S, Balestrazzi E, Mei R, Farolfi A, Vetrone L, Serani F, Calderoni L, Stretta M, Morganti A, Schiavina R, Castellucci P, Fanti S, Brunocilla E. PSMA-PET in high-risk prostate cancer patients suitable for radical treatments: Scenario of detection and clinical impact for staging setting. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00118-5] [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: 02/12/2023]
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15
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Guido A, Cuicchi D, Castellucci P, Cellini F, Di Fabio F, Llimpe FLR, Strigari L, Buwenge M, Cilla S, Deodato F, Macchia G, Galietta E, Golfieri R, Ardizzoni A, Zagari RM, Fanti S, Poggioli G, Fuccio L, Morganti AG. Adaptive Individualized high-dose preoperAtive (AIDA) chemoradiation in high-risk rectal cancer: a phase II trial. Eur J Nucl Med Mol Imaging 2023; 50:572-580. [PMID: 36127416 PMCID: PMC9816267 DOI: 10.1007/s00259-022-05944-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the pathological complete response (pCR) rate of locally advanced rectal cancer (LARC) after adaptive high-dose neoadjuvant chemoradiation (CRT) based on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT). METHODS The primary endpoint was the pCR rate. Secondary endpoints were the predictive value of 18 F-FDG-PET/CT on pathological response and acute and late toxicity. All patients performed 18 F-FDG-PET/CT at baseline (PET0) and after 2 weeks during CRT (PET1). The metabolic PET parameters were calculated both at the PET0 and PET1. The total CRT dose was 45 Gy to the pelvic lymph nodes and 50 Gy to the primary tumor, corresponding mesorectum, and to metastatic lymph nodes. Furthermore, a sequential boost was delivered to a biological target volume defined by PET1 with an additional dose of 5 Gy in 2 fractions. Capecitabine (825 mg/m2 twice daily orally) was prescribed for the entire treatment duration. RESULTS Eighteen patients (13 males, 5 females; median age 55 years [range, 41-77 years]) were enrolled in the trial. Patients underwent surgical resection at 8-9 weeks after the end of neoadjuvant CRT. No patient showed grade > 1 acute radiation-induced toxicity. Seven patients (38.8%) had TRG = 0 (complete regression), 5 (27.0%) showed TRG = 2, and 6 (33.0%) had TRG = 3. Based on the TRG results, patients were classified in two groups: TRG = 0 (pCR) and TRG = 1, 2, 3 (non pCR). Accepting p < 0.05 as the level of significance, at the Kruskal-Wallis test, the medians of baseline-MTV, interim-SUVmax, interim-SUVmean, interim-MTV, interim-TLG, and the MTV reduction were significantly different between the two groups. 18 F-FDG-PET/CT was able to predict the pCR in 77.8% of cases through compared evaluation of both baseline PET/CT and interim PET/CT. CONCLUSIONS Our results showed that a dose escalation on a reduced target in the final phase of CRT is well tolerated and able to provide a high pCR rate.
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Affiliation(s)
- Alessandra Guido
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dajana Cuicchi
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Roma, Italy.
- Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Agostino Gemelli 8, 00168, Roma, Italy.
| | - Francesca Di Fabio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Agostino Gemelli 8, 00168, Roma, Italy
- Radiation Oncology, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Ardizzoni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Rocco Maurizio Zagari
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Gastroenterology Unit, Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Digestive Medicine and Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lorenzo Fuccio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Gastroenterology Unit, Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
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16
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Bianchi L, Ceci F, Costa F, Balestrazzi E, Droghetti M, Piazza P, Pissavini A, Mei R, Farolfi A, Castellucci P, Puliatti S, Larcher A, Gandaglia G, Robesti D, Mottrie A, Briganti A, Morganti AG, Fanti S, Montorsi F, Schiavina R, Brunocilla E. The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence. Cancers (Basel) 2022; 15:cancers15010247. [PMID: 36612242 PMCID: PMC9818949 DOI: 10.3390/cancers15010247] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is currently recommended to restage prostate cancer (PCa) and to guide the delivery of salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. Methods: 324 hormone-sensitive PCa with PSA relapse after radical prostatectomy who underwent PSMA-PET in three high-volume European Centres. Patients have been stratified as pre-salvage who never received salvage treatments (n = 134), and post-salvage, including patients who received previous salvage therapies (n = 190). Patients with oligorecurrent (≤3 lesions), PSMA-positive disease underwent PSMA-directed treatments: salvage radiotherapy (sRT) or Metastases-directed therapy (MDT). Patients with polirecurrent (>3 lesions) PSMA-positive disease were treated with systemic therapy. Patients with negative PSMA-PET were treated with sRT or systemic therapies or observation. The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were: Metastases-free survival (MFS) and Castration Resistant Pca free survival (CRPC-FS). Results: median follow up was 23 months. In the pre-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 66.2% vs. 38.9%, 95.2% vs. 73.7% and 94.9% vs. 93.1% in patients with negative vs. positive PSMA-PET, respectively (all p ≥ 0.2). In the post-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 59.5% vs. 29.1%, 92.7% vs. 65.1% and 98.8% vs. 88.8% in patients with negative vs. positive PSMA-PET, respectively (all p ≤ 0.01). At multivariable analyses, a positive PSMA-PET was an independent predictor of progression (HR = 2.15) and metastatic disease (HR 2.37; all p ≤ 0.03). Conclusion: PSMA-PET in recurrent PCa detects the site of recurrence guiding salvage treatments and has a prognostic role in patients who received previous salvage treatments.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
- University of Bologna, 40126 Bologna, Italy
- Correspondence:
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Francesco Costa
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Alessandro Pissavini
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Riccardo Mei
- Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, 41122 Modena, Italy
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, 9300 Aalst, Belgium
- ORSI Academy, 9300 Melle, Belgium
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Daniele Robesti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, 9300 Aalst, Belgium
- ORSI Academy, 9300 Melle, Belgium
| | - Alberto Briganti
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | | | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
- University of Bologna, 40126 Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy
- University of Bologna, 40126 Bologna, Italy
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Bianchi L, Vetrone L, Mei R, Farolfi A, Giunchi F, De Giovanni A, Serani F, Costa F, Droghetti M, Pissavini A, Schiavina R, Brunocilla E, Castellucci P, Fanti S. Immunohistochemical PSMA expression and histology predictors in primary staging high-risk prostate cancer patients studied with PSMA PET/CT. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02468-5] [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: 11/11/2022] Open
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18
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Ferioli M, Perrone AM, Castellucci P, Panni V, Benini A, Macchia G, Galuppi A, Buwenge M, Lodi Rizzini E, Strigari L, Tagliaferri L, Zamagni C, De Iaco P, Fanti S, Morganti AG. Adjuvant radiotherapy of endometrial cancer: role of 18F-FDG-PET/CT in treatment modulation. EUR J GYNAECOL ONCOL 2022. [DOI: 10.31083/j.ejgo4302028] [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: 11/06/2022]
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19
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Medici F, Siepe G, Strigari L, Massari F, Buwenge M, Bisello S, Castellucci P, Fanti S, Cammelli S, Morganti A. CARE‑compliant stereotactic radiotherapy of urothelial nodal metastases: A case report. Mol Clin Oncol 2022; 16:85. [PMID: 35251636 PMCID: PMC8892461 DOI: 10.3892/mco.2022.2518] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
The aim of the present study was to report the case of a 58-year-old male patient with ureteral carcinoma who underwent ureteroileostomy treatment. At 2 years following surgery, six lymph node metastases (LNMs) were detected in the patient's para-aortic and pelvic regions using 18F-labeled fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT. All LNMs were treated using stereotactic body radiotherapy (SBRT; 35-40 Gy/5 fractions). At 3 months after radiotherapy, 18F-FDG-PET/CT examination revealed a complete radiological and metabolic response of all targeted treatment sites in the patient. In the 2 years following radiotherapy, another three same-dose SBRT treatments were performed on single or multiple LNMs, which were all detected in the abdomen and pelvis of the patient. Overall, a total of 11 LNMs were targeted in the patient and all exhibited complete radiological and metabolic response following treatment. The only treatment side effect reported by the patient was a slight and temporary loss of appetite. In patients with lymph node oligometastases there are two options for radiotherapy: i) Irradiation focusing on LNMs alone; and ii) prophylactic irradiation of the entire lymph node area combined with a boost on macroscopic lesions. In the patient discussed in the present study, the choice of irradiation focusing on LNMs alone made it possible to postpone systemic therapies and instead use an optimally tolerated treatment. The treatment outcome in this patient indicated that there was no radioresistance of urothelial LNMs.
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Affiliation(s)
- Federica Medici
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
| | - Giambattista Siepe
- Radiation Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Francesco Massari
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
| | - Silvia Bisello
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero‑Universitaria di Bologna, I-40138 Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
| | - Alessio Morganti
- Radiation Oncology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum Bologna University, I-40138 Bologna, Italy
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20
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Abstract
Prostate-specific membrane antigen (PSMA) is a molecular target for both imaging diagnostics and therapeutics, i.e., a theragnostics target. There has been a growing body of evidence supporting PSMA theragnostics approaches in the management of prostate cancer (PCa) for tailored precision medicine. Tumor characterization through PSMA-ligand PET imaging is crucial for assessing the molecular signature and eligibility for PSMA radioligand therapy. Recent U.S. Food and Drug Administration (FDA) approval of two new drug applications for PSMA PET imaging contribute to reinforce PSMA as an oncologic blockbuster. Additionally, relevant progress in the PSMA treatment has been made in the last five years. [177Lu]Lu-PSMA-617 radioligand therapy for patients with progressive PSMA-avid metastatic castration-resistant PCa (mCRPC) significantly increased overall survival and radiographic progression-free survival, according to the results of an international, prospective, open label, multicenter, randomized, phase III study (VISION trial). The objective of this comprehensive review is to highlight the recent advances in PCa theragnostics, focusing on actual clinical applications and future perspectives.
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Affiliation(s)
- Andrea Farolfi
- Division of Nuclear Medicine, IRCCS University Hospital of Bologna, Bologna, Italy -
| | - Riccardo Mei
- Division of Nuclear Medicine, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Sakaria Ali
- Department of Pediatrics, University College London Hospital, London, UK
| | - Paolo Castellucci
- Division of Nuclear Medicine, IRCCS University Hospital of Bologna, Bologna, Italy
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21
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Droghetti M, Bianchi L, Costa F, Balestrazzi E, Chessa F, Ceci F, Mei R, Farolfi A, Castellucci P, Piazza P, Puliatti S, Larcher A, Gandaglia G, Mottrie A, Briganti A, Fanti S, Montorsi F, Schiavina R, Brunocilla E. Oncological outcomes in patients with recurrent prostate cancer staged with PSMA PET/CT: Results from 3 European tertiary centers. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00276-7] [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: 11/26/2022]
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22
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Bianchi L, Mattana F, Balesrtazzi E, Farolfi A, Angiolini A, Droghetti M, Ercolino A, Farneti F, Morganti A, Briganti A, Montorsi F, Schiavina R, Brunocilla E, Castellucci P, Fanti S. 68Ga PSMA PET/CT for staging high risk prostate cancer patients suitable for radical treatments: Effective clinic implication and preliminary diagnostic performance. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03090-1] [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: 11/17/2022] Open
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23
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Bianchi L, Ceci F, Droghetti M, Castellucci P, Artigas C, Leite J, Corona P, Farolfi A, Shagera Q, Moreira R, Gonzales C, Queiroz M, Barbosa F, Schiavina R, Brunocilla E, Deandreis D, Fanti S. External validation of a nomogram for predicting 68GA-PSMA PET/CT detection rate in patients with prostate cancer recurrence: a clinical tool to guide physicians before suggesting 68GA-PSMA PET/CT. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00968-x] [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: 11/26/2022] Open
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24
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Farolfi A, Telo S, Castellucci P, Morais de Campos AL, Rosado-de-Castro PH, Altino de Almeida S, Artigas C, Scarlattei M, Leal A, Deandreis D, Fanti S, Fendler WP, Mosconi C, Pianori D, Ruffini L, Ceci F. Lung uptake detected by 68Ga-PSMA-11 PET/CT in prostate cancer patients with SARS-CoV-2: a case series. Am J Nucl Med Mol Imaging 2021; 11:300-306. [PMID: 34513283 PMCID: PMC8414400] [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] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pathology is associated with neoangiogenesis and interstitial pneumonia. 68Ga-PSMA-11-PET/CT is able to image in vivo PSMA (Prostate-Specific Membrane Antigen) expression on both prostate cancer (PCa) cells and neovasculature endothelial cells. The aim of the case series was to explore pulmonary PSMA expression not related to cancer in patients with PCa and concomitant COVID-19. In this retrospective, multicenter case series, patients who underwent 68Ga-PSMA-11-PET/CT for PCa and concomitant proven COVID-19 infection were analyzed. Patients were stratified according to 68Ga-PSMA-11 intensity of uptake in the lung (SUVmax). Low uptake: < blood pool; mild-to-moderate uptake: > blood pool and < liver; intense uptake: > liver. Potential correlation between pulmonary 68Ga-PSMA-11 uptake not related to PCa and CT patterns typical for COVID-19 was assessed. Nine patients were included, all of them presenting abnormal 68Ga-PSMA-11 uptake, at different grades: 2/9 low, 6/9 mild-to-moderate, 1/9 high. Uptake distribution was generally bilateral, peripheral and posterior, positively matching with ground-glass CT alterations in 7/9 (78%) patients, while mismatch was observed in 2/9 (22%). 1/9 patients presented PCa lung metastases at 68Ga-PSMA-11. 68Ga-PSMA-11-PET/CT detected increased PSMA uptake within the lung, not related to PCa, matching with CT typical COVID-19 patterns in almost all patients. Further studies are needed to evaluate the role of 68Ga-PSMA-11 PET in COVID-19 patients and the potential role of PSMA overexpression as a biomarker for neoangiogenesis, in both oncological and infective disorders.
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Affiliation(s)
- Andrea Farolfi
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna, Italy
| | - Silvi Telo
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna, Italy
| | | | | | | | - Carlos Artigas
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de BruxellesBrussels, Belgium
| | - Maura Scarlattei
- Nuclear Medicine Department, Azienda Ospedaliero-UniversitariaParma, Italy
| | - Aline Leal
- Nuclear Medicine, Real Hospital Portugues de PernambucoRecife, Brazil
| | - Desiree Deandreis
- Nuclear Medicine, Department of Medical Sciences, University of TurinTurin, Italy
| | - Stefano Fanti
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di BolognaBologna, Italy
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital EssenEssen, Germany
| | - Cristina Mosconi
- Department of Radiology, IIRCCS Azienda Ospedaliero-Universitaria di BolognaBologna, Italy
| | - Davide Pianori
- Department of Biomedical and Neuromotor Sciences, University of BolognaBologna, Italy
| | - Livia Ruffini
- Nuclear Medicine Department, Azienda Ospedaliero-UniversitariaParma, Italy
| | - Francesco Ceci
- Nuclear Medicine, Department of Medical Sciences, University of TurinTurin, Italy
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25
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Mei R, Farolfi A, Castellucci P, Nanni C, Zanoni L, Fanti S. PET/CT variants and pitfalls in prostate cancer: What you might see on PET and should never forget. Semin Nucl Med 2021; 51:621-632. [PMID: 34266631 DOI: 10.1053/j.semnuclmed.2021.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
2-deoxy-2-[18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) gained an impressive role in the diagnostic management of many oncological diseases, even though its use in imaging prostate cancer (PC) is limited to selected cases, mostly advanced stage of PC and selection for prostate specific antigen membrane (PSMA) radioligand therapy (RLT). In the past years, several PET tracers have been developed for both staging and restaging PC. The three most employed PET molecules in daily practice are [11C] or [18F]F-Choline, [18F]F-Fluciclovine (Anti-1- amino-3-[18F]Fluorocyclobutane-1-Carboxylic Acid, also known as (Anti-[18F]FACBC), [68Ga]Ga-PSMA and recently FDA approved the first Fluorinated PSMA-based named [18F]F-DCFPyl. Each one has its own physiological and peculiarity which are worth exploring. Moreover, an increasing number of case reports and studies have reported tracers' variants, pitfalls, or even non-prostatic diseases (benign and malignant) incidentally detected. In prostate oncology, PET can be performed with several indications in different stages of disease, as highlighted in the EAU Guidelines on PC. A correct scan interpretation depends on the knowledge of both the physiological distribution of the tracers and the uptake of possible variants and pitfalls. The aim of this critical review is to provide a comprehensive knowledge of physiological distribution of these three tracers, as well as an updated overview of variants and pitfalls.
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Affiliation(s)
- Riccardo Mei
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Italy.
| | - Andrea Farolfi
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lucia Zanoni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Italy
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26
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Castellucci P, Savoia F, Farina A, Lima GM, Patrizi A, Baraldi C, Zagni F, Vichi S, Pettinato C, Morganti AG, Strigari L, Fanti S. Correction to: High dose brachytherapy with non sealed 188Re (rhenium) resin in patients with non-melanoma skin cancers (NMSCs): single center preliminary results. Eur J Nucl Med Mol Imaging 2021; 48:1706. [PMID: 33871669 DOI: 10.1007/s00259-021-05363-7] [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: 10/21/2022]
Affiliation(s)
- Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - F Savoia
- Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - A Farina
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - G M Lima
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - A Patrizi
- Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - C Baraldi
- Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - F Zagni
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - S Vichi
- Department of Industrial Engineering, Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - C Pettinato
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy.,Medical Physics Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Milano, Milan, Italy
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - L Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - S Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
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27
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Mei R, Bracarda S, Emmett L, Farolfi A, Lambertini A, Fanti S, Castellucci P. Androgen deprivation therapy and its modulation of PSMA expression in prostate cancer: mini review and case series of patients studied with sequential [68Ga]-Ga-PSMA-11 PET/CT. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00421-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Farolfi A, Calderoni L, Mattana F, Mei R, Telo S, Fanti S, Castellucci P. Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer. J Nucl Med 2021; 62:596-604. [PMID: 33712536 DOI: 10.2967/jnumed.120.257238] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [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: 01/19/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) is highly expressed on most prostate cancer (PCa) cells, and several PSMA ligands for PET imaging are now available worldwide. 68Ga-PSMA-11 has already received U.S. Food and Drug Administration and European Medicines Agency approval, and use of PSMA PET is currently suggested by several international guidelines for investigating PCa in different clinical settings. In primary PCa, PSMA PET has been shown to be superior to cross-sectional imaging for the detection of pelvic lymph nodes and distant metastases with subsequent clinical management changes. Additionally, it might also have a role in intraprostatic tumor localization, especially when combined with multiparametric MRI. In a setting of PCa recurrence, higher detection rates have been observed than for any other available imaging techniques, especially at low prostate-specific antigen values. Furthermore, PSMA PET consistently led to a shift in clinical management, thus increasing the proportion of radiotherapy, surgery, or other focal therapies at the expense of systemic options or no treatment. In oligometastatic disease after radical surgery, PSMA PET may be relevant in guiding a metastasis-directed therapy approach, as preliminary data seem to suggest a benefit in terms of progression-free survival after treatment of PSMA PET-positive lesions. As a staging and gatekeeping technique, PSMA PET represents a reliable whole-body imaging procedure in combination with second-line therapy of castration-resistant PCa, as well as being pivotal when assessing patients eligible for radioligand therapy such as 177Lu-PSMA. This critical review aims at providing a comprehensive overview of the latest literature on the current or emerging main indications, as well as a general outlook on the recommended interpretation criteria for PSMA PET imaging.
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Affiliation(s)
- Andrea Farolfi
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Letizia Calderoni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Francesco Mattana
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Riccardo Mei
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Sivi Telo
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, Bologna, Italy
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Castellucci P, Savoia F, Farina A, Lima GM, Patrizi A, Baraldi C, Zagni F, Vichi S, Pettinato C, Morganti AG, Strigari L, Fanti S. High dose brachytherapy with non sealed 188Re (rhenium) resin in patients with non-melanoma skin cancers (NMSCs): single center preliminary results. Eur J Nucl Med Mol Imaging 2020; 48:1511-1521. [PMID: 33140131 PMCID: PMC8113182 DOI: 10.1007/s00259-020-05088-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022]
Abstract
Background and aim High dose brachytherapy using a non sealed 188Re-resin (Rhenium-SCT®, Oncobeta® GmbH, Munich, Germany) is a treatment option for non-melanoma skin cancer (NMSC). The aim of this prospective study was to assess the efficacy and the safety of a single application of Rhenium-SCT® in NMSC. Materials and method Fifty consecutive patients (15F, 35 M, range of age 56–97, mean 81) showing 60 histologically proven NMSCs were enrolled and treated with the Rhenium-SCT® between October 2017 and January 2020. Lesions were located on the face, ears, nose or scalp (n = 46), extremities (n = 9), and trunk (n = 5). Mean surface areas were 7.0 cm2 (1–36 cm2), mean thickness invasion was 1.1 mm (0.2–2.5 mm), and mean treatment time was 79 min (21–85 min). Superficial, mean, and target absorbed dose were 185 Gy, 63 Gy, and 31 Gy respectively. Patients were followed-up at 14, 30, 60, 90, and 180 days posttreatment, when dermoscopy and biopsy were performed. Mean follow-up was 20 months (range 3–33 months). Early skin toxicity was classified according to Common Terminology Criteria for Adverse Events (CTCAE). Cosmetic results were evaluated after at least 12 months according to Radiation Therapy Oncology Group (RTOG) scale. Results At 6 months follow-up, histology and dermoscopy were available for 54/60 lesions, of which 53/54 (98%) completely responded. One patient showed a 1-cm2 residual lesion that was subsequently surgically excised. Twelve months after treatment, 41/41 evaluable lesions were free from relapse. Twenty four months after treatment, 23/24 evaluable lesions were free of relapse. In 56/60 lesions early side effects, resolving within 32 days were classified as grades 1–2 (CTCAE). In the remaining 4/60 lesions, these findings were classified as grade 3 (CTCAE) and lasted up to 8–12 weeks but all resolved within 90 days. After at least 12 months (12–33 months), cosmetic results were excellent (30 lesions) or good (11 lesions). Conclusion High dose brachytherapy with Rhenium-SCT® is a noninvasive, reasonably safe, easy to perform, effective and well-tolerated approach to treat NMSCs, and it seems to be a useful alternative option when surgery or radiation therapy are difficult to perform or not recommended. In our population 98% of the treated lesions resolved completely after a single application and only one relapsed after 2 years. Larger patients’ population and longer follow-up are needed to confirm these preliminary data and to find the optimal dose to administer in order to achieve complete response without significant side effects.
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Affiliation(s)
- Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - F Savoia
- Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - A Farina
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - G M Lima
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - A Patrizi
- Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - C Baraldi
- Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - F Zagni
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - S Vichi
- Department of Industrial Engineering, Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - C Pettinato
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy.,Medical Physics Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Milano, Milan, Italy
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - L Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - S Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
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Farolfi A, Hirmas N, Gafita A, Weber M, Barbato F, Wetter A, Mei R, Pianori D, Hadaschik B, Herrmann K, Castellucci P, Fanti S, Eiber M, Fendler WP. Identification of PCWG3 Target Populations Is More Accurate and Reproducible with PSMA PET Than with Conventional Imaging: A Multicenter Retrospective Study. J Nucl Med 2020; 62:675-678. [DOI: 10.2967/jnumed.120.246603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022] Open
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Barwick TD, Castellucci P. Invited Commentary: Prostate-specific Membrane Antigen PET Response Assessment—Has the Time Come? Radiographics 2020; 40:1431-1433. [DOI: 10.1148/rg.2020200165] [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: 11/11/2022]
Affiliation(s)
- Tara D. Barwick
- From the Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, England (T.D.B); and Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy (P.C)
| | - Paolo Castellucci
- From the Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, England (T.D.B); and Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy (P.C)
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Francolini G, Detti B, Bottero M, Zilli T, Lancia A, Bruni A, Borghesi S, Mariotti M, Castellucci P, Fanti S, Filippi AR, Teriaca MA, Maragna V, Aristei C, Mazzeo E, Livi L, Ingrosso G. Detection rate, pattern of relapse and influence on therapeutic decision of PSMA PET/CT in patients affected by biochemical recurrence after radical prostatectomy, a retrospective case series. Clin Transl Oncol 2020; 23:364-371. [PMID: 32602076 DOI: 10.1007/s12094-020-02427-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
Abstract
AIMS 68Ga-Prostate-specific membrane antigen (PSMA) PET/CT is widely used in patients with biochemical recurrence (BCR) after radical prostatectomy. We collected data about patients staged with PSMA PET/CT after BCR (PSA < 1 ng/ml) in four different institutes. Impact of baseline features (Gleason score, risk classification, PSA at recurrence, PSA doubling time and time to recurrence) was explored to understand predictive factors of (PSMA) PET/CT positivity. Impact of restaging on following treatment approaches was reported. RESULTS 92 patients were included. PSMA PET/CT detection rate was 56.5% and low-volume disease (≤ 3 non-visceral lesions) was detected in 52.2% of patients. After positive scan, 13.5% of patients still lies on observation, ADT alone was administered in 30.8% of cases, Stereotactic body RT (SBRT) alone was delivered to 44.2% of patients and 11.5% of patients underwent concomitant SBRT and ADT. Seven patients underwent conventional salvage prostate bed RT. Chi-squared test showed a higher rate of positive PSMA PET/CT for patients with Gleason score > 7 (p = 0.004) and TTR < 29.5 months (p = 0.003). CONCLUSIONS PSMA PET/CT showed a high detection rate. This influenced clinical management in a significant percentage of patients, allowing treatment tailoring on the basis of imaging.
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Affiliation(s)
- G Francolini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - B Detti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - M Bottero
- Department of Radiation Oncology, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - T Zilli
- Radiation Oncology Division, Geneva University Hospital, Geneva, Switzerland
| | - A Lancia
- Radiation Oncology Unit, Department of Medical Sciences and Infectious Disease, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - A Bruni
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - S Borghesi
- UOC Radiation Oncology Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - M Mariotti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - P Castellucci
- Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - A R Filippi
- Radiation Oncology Unit, Department of Medical Sciences and Infectious Disease, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - M A Teriaca
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - V Maragna
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - C Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
| | - E Mazzeo
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - L Livi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - G Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
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Barwick TD, Castellucci P. Invited Commentary: Changing Landscape of Imaging in Recurrent Prostate Cancer. Radiographics 2020; 40:727-730. [DOI: 10.1148/rg.2020190215] [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: 11/11/2022]
Affiliation(s)
- Tara D. Barwick
- From the Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, England (T.D.B.); and Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy (P.C.)
| | - Paolo Castellucci
- From the Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, England (T.D.B.); and Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy (P.C.)
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Perrone AM, Dondi G, Coe M, Ferioli M, Telo S, Galuppi A, De Crescenzo E, Tesei M, Castellucci P, Nanni C, Fanti S, Morganti AG, De Iaco P. Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study. Cancers (Basel) 2020; 12:E659. [PMID: 32178252 PMCID: PMC7139894 DOI: 10.3390/cancers12030659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 02/22/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023] Open
Abstract
Tumor response in locally advanced cervical cancer (LACC) is generally evaluated with MRI and PET, but this strategy is not supported by the literature. Therefore, we compared the diagnostic performance of these two techniques in the response evaluation to concurrent chemoradiotherapy (CCRT) in LACC. Patients with cervical cancer (CC) stage T2b treated with CCRT and submitted to MRI and PET/CT before and after treatment were enrolled in the study. All clinical, pathological, therapeutic, radiologic and follow-up data were collected and examined. The radiological response was analyzed and compared to the follow-up data. Data of 40 patients with LACC were analyzed. Agreement between MRI and PET/CT in the evaluation response to therapy was observed in 31/40 (77.5%) of cases. The agreement between MRI, PET/CT and follow-up data showed a Cohen kappa coefficient of 0.59 (95% CI = 0.267-0.913) and of 0.84 (95% CI = 0.636-1.00), respectively. Considering the evaluation of primary tumor response, PET/CT was correct in 97.5% of cases, and MRI in 92.5% of cases; no false negative cases were observed. These results suggest the use of PET/CT as a unique diagnostic imaging tool after CCRT, to correctly assess residual and progression disease.
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Affiliation(s)
- Anna Myriam Perrone
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
| | - Giulia Dondi
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
| | - Manuela Coe
- Department of Specialized, Diagnostic, and Experimental Medicine, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Martina Ferioli
- Radiotherapy Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Silvi Telo
- Nuclear Medicine Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (S.T.); (P.C.); (C.N.)
| | - Andrea Galuppi
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
- Radiotherapy Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Eugenia De Crescenzo
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
| | - Marco Tesei
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
| | - Paolo Castellucci
- Nuclear Medicine Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (S.T.); (P.C.); (C.N.)
| | - Cristina Nanni
- Nuclear Medicine Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (S.T.); (P.C.); (C.N.)
| | - Stefano Fanti
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
- Nuclear Medicine Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (S.T.); (P.C.); (C.N.)
| | - Alessio G. Morganti
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
- Radiotherapy Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Pierandrea De Iaco
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
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Bianchi L, Borghesi M, Schiavina R, Castellucci P, Ercolino A, Bianchi FM, Barbaresi U, Polverari G, Brunocilla E, Fanti S, Ceci F. Predictive accuracy and clinical benefit of a nomogram aimed to predict 68Ga-PSMA PET/CT positivity in patients with prostate cancer recurrence and PSA < 1 ng/ml external validation on a single institution database. Eur J Nucl Med Mol Imaging 2020; 47:2100-2105. [PMID: 32006061 DOI: 10.1007/s00259-020-04696-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To perform an external validation of a recently published nomogram aimed to predict positive 68Ga-PSMA-11 PET/CT in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) by Rauscher et al. (Eur Urol 73(5):656-661, 2018). METHODS Overall, 413 PCa patients with BCR after RP (two consecutive PSA ≥ 0.2 ng/ml) and PSA value between 0.2 and 1 ng/ml were included. A multivariable logistic regression model was produced to assess the predictors of positive 68Ga-PSMA-11 PET/CT results. The performance characteristics of the model were assessed by quantifying the predictive accuracy, according to model calibration. Yuden's index was used to find the best nomogram's cut-off. Finally, decision curve analysis (DCA) was implemented to quantify the nomogram's clinical value. RESULTS In the external cohort, the overall detection rate of 68Ga-PSMA-11 PET/CT was 44% vs. 64.7% in the original population. At multivariate analysis, PSA at 68Ga-PSMA-11 PET/CT (OR: 7.06, p < 0.001) and ongoing ADT at time of 68Ga-PSMA-11 PET/CT (OR: 2.07, p = 0.03) were the only independent predictors of PET/CT positivity. The predictive accuracy of nomogram was suboptimal and comparable to that reported in the original model (64% vs. 67%, respectively). The calibration plot indicated suboptimal concordance. The best nomogram's cut-off to predict positive 68Ga-PSMA-11 PET/CT was 35% (AUC = 0.61). In DCA, the nomogram revealed clinical net benefit when the threshold probabilities of positive 68Ga-PSMA-11 PET/CT is > 35%. CONCLUSION We assessed similar suboptimal predictive accuracies in the external cohort compared to the original one. PSA and ongoing ADT were confirmed as positive predictors, and the most informative nomogram cut-off resulted 35%.
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Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy. .,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy.
| | - Marco Borghesi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Paolo Castellucci
- Metropolitan Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Amelio Ercolino
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy
| | - Federico Mineo Bianchi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy
| | - Umberto Barbaresi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy
| | - Giulia Polverari
- Metropolitan Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Metropolitan Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy.,Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
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Telo S, Calderoni L, Vichi S, Zagni F, Castellucci P, Fanti S. Alternative and New Radiopharmaceutical Agents for Lung Cancer. Curr Radiopharm 2020; 13:185-194. [PMID: 31868150 PMCID: PMC8206190 DOI: 10.2174/1874471013666191223151402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/06/2019] [Revised: 01/27/2019] [Accepted: 11/11/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND FDG PET/CT imaging has an established role in lung cancer (LC) management. Whilst it is a sensitive technique, FDG PET/CT has a limited specificity in the differentiation between LC and benign conditions and is not capable of defining LC heterogeneity since FDG uptake varies between histotypes. OBJECTIVE To get an overview of new radiopharmaceuticals for the study of cancer biology features beyond glucose metabolism in LC. METHODS A comprehensive literature review of PubMed/Medline was performed using a combination of the following keywords: "positron emission tomography", "lung neoplasms", "non-FDG", "radiopharmaceuticals", "tracers". RESULTS Evidences suggest that proliferation markers, such as 18F-Fluorothymidine and 11CMethionine, improve LC staging and are useful in evaluating treatment response and progression free survival. 68Ga-DOTA-peptides are already routinely used in pulmonary neuroendocrine neoplasms (NENs) management and should be firstly performed in suspected NENs. 18F-Fluoromisonidazole and other radiopharmaceuticals show a promising impact on staging, prognosis assessment and therapy response in LC patients, by visualizing hypoxia and perfusion. Radiolabeled RGD-peptides, targeting angiogenesis, may have a role in LC staging, treatment outcome and therapy. PET radiopharmaceuticals tracing a specific oncogene/signal pathway, such as EGFR or ALK, are gaining interest especially for therapeutic implications. Other PET tracers, like 68Ga-PSMA-peptides or radiolabeled FAPIs, need more development in LC, though, they are promising for therapy purposes. CONCLUSION To date, the employment of most of the described tracers is limited to the experimental field, however, research development may offer innovative opportunities to improve LC staging, characterization, stratification and response assessment in an era of increased personalized therapy.
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Affiliation(s)
- Silvi Telo
- Address correspondence to this author at the Department of Metropolitan Nuclear Medicine, University of Bologna, Bologna, Italy; Tel/Fax: +390512143959; E-mail:
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Sánchez-Izquierdo N, Calderoni L, Farolfi A, Paredes P, Fuster D, Castellucci P. 11C-Choline PET/CT detects multiple small peritoneal metastasis in a prostate cancer patient. Rev Esp Med Nucl Imagen Mol 2019; 39:104-105. [PMID: 31810773 DOI: 10.1016/j.remn.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/26/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - L Calderoni
- Department of Nuclear Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bolonia, Italia
| | - A Farolfi
- Department of Nuclear Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bolonia, Italia
| | - P Paredes
- Departamento de Medicina Nuclear, Hospital Clínic, Barcelona, España
| | - D Fuster
- Departamento de Medicina Nuclear, Hospital Clínic, Barcelona, España
| | - P Castellucci
- Department of Nuclear Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bolonia, Italia
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Affiliation(s)
- Silvi Telo
- Nuclear Medicine, S. Orsola University Hospital, Bologna, Italy
| | - Andrea Farolfi
- Nuclear Medicine, S. Orsola University Hospital, Bologna, Italy
| | | | - Stefano Fanti
- Nuclear Medicine, S. Orsola University Hospital, Bologna, Italy
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Giammarile F, Castellucci P, Dierckx R, Estrada Lobato E, Farsad M, Hustinx R, Jalilian A, Pellet O, Rossi S, Paez D. Non-FDG PET/CT in Diagnostic Oncology: a pictorial review. Eur J Hybrid Imaging 2019; 3:20. [PMID: 34191163 PMCID: PMC8218094 DOI: 10.1186/s41824-019-0066-2] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) is currently one of the main imaging modalities for cancer patients worldwide. Fluorodeoxyglucose (FDG) PET/CT has earned its global recognition in the modern management of cancer patients and is rapidly becoming an important imaging modality for patients with cardiac, neurological, and infectious/inflammatory conditions. Despite its proven benefits, FDG has limitations in the assessment of several relevant tumours such as prostate cancer. Therefore, there has been a pressing need for the development and clinical application of different PET radiopharmaceuticals that could image these tumours more precisely. Accordingly, several non-FDG PET radiopharmaceuticals have been introduced into the clinical arena for management of cancer. This trend will undoubtedly continue to spread internationally. The use of PET/CT with different PET radiopharmaceuticals specific to tumour type and biological process being assessed is part of the personalised precision medicine approach. The objective of this publication is to provide a case-based method of understanding normal biodistribution, variants, and pitfalls, including several examples of different imaging appearances for the main oncological indications for each of the new non-FDG PET radiopharmaceuticals. This should facilitate the interpretation and recognition of common variants and pitfalls to ensure that, in clinical practice, the official report is accurate and helpful. Some of these radiopharmaceuticals are already commercially available in many countries (e.g. 68Ga-DOTATATE and DOTATOC), others are in the process of becoming available (e.g. 68Ga-PSMA), and some are still being researched. However, this list is subject to change as some radiopharmaceuticals are increasingly utilised, while others gradually decrease in use.
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Affiliation(s)
- Francesco Giammarile
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
| | - Paolo Castellucci
- Department of Nuclear Medicine, Sant'Orsola-Malpighi Hospital, 40138, Bologna, Italy
| | - Rudi Dierckx
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Enrique Estrada Lobato
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Mohsen Farsad
- Department of Nuclear Medicine, Bolzano Hospital, Bolzano, Italy
| | - Roland Hustinx
- Department of Nuclear Medicine, CHU Liège, University of Liège, Liège, Belgium
| | - Amirreza Jalilian
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Olivier Pellet
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Susana Rossi
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - Diana Paez
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
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Calderoni L, Farolfi A, Pianori D, Maietti E, Cabitza V, Lambertini A, Ricci G, Telo S, Lodi F, Castellucci P, Fanti S. Evaluation of an Automated Module Synthesis and a Sterile Cold Kit–Based Preparation of 68Ga-PSMA-11 in Patients with Prostate Cancer. J Nucl Med 2019; 61:716-722. [DOI: 10.2967/jnumed.119.231605] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
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41
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Ceci F, Bianchi L, Borghesi M, Polverari G, Farolfi A, Briganti A, Schiavina R, Brunocilla E, Castellucci P, Fanti S. Prediction nomogram for 68Ga-PSMA-11 PET/CT in different clinical settings of PSA failure after radical treatment for prostate cancer. Eur J Nucl Med Mol Imaging 2019; 47:136-146. [PMID: 31492993 DOI: 10.1007/s00259-019-04505-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to develop a clinical nomogram to predict gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11-PET/CT) positivity in different clinical settings of PSA failure. MATERIALS AND METHODS Seven hundred three (n = 703) prostate cancer (PCa) patients with confirmed PSA failure after radical therapy were enrolled. Patients were stratified according to different clinical settings (first-time biochemical recurrence [BCR]: group 1; BCR after salvage therapy: group 2; biochemical persistence after radical prostatectomy [BCP]: group 3; advanced-stage PCa before second-line systemic therapies: group 4). First, we assessed 68Ga-PSMA-11-PET/CT positivity rate. Second, multivariable logistic regression analyses were used to determine predictors of positive scan. Third, regression-based coefficients were used to develop a nomogram predicting positive 68Ga-PSMA-11-PET/CT result and 200 bootstrap resamples were used for internal validation. Fourth, receiver operating characteristic (ROC) analysis was used to identify the most informative nomogram's derived cutoff. Decision curve analysis (DCA) was implemented to quantify nomogram's clinical benefit. RESULTS 68Ga-PSMA-11-PET/CT overall positivity rate was 51.2%, while it was 40.3% in group 1, 54% in group 2, 60.5% in group 3, and 86.9% in group 4 (p < 0.001). At multivariable analyses, ISUP grade, PSA, PSA doubling time, and clinical setting were independent predictors of a positive scan (all p ≤ 0.04). A nomogram based on covariates included in the multivariate model demonstrated a bootstrap-corrected accuracy of 82%. The nomogram-derived best cutoff value was 40%. In DCA, the nomogram revealed clinical net benefit of > 10%. CONCLUSIONS This novel nomogram proved its good accuracy in predicting a positive scan, with values ≥ 40% providing the most informative cutoff in counselling patients to 68Ga-PSMA-11-PET/CT. This tool might be important as a guide to clinicians in the best use of PSMA-based PET imaging.
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Affiliation(s)
- Francesco Ceci
- Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
- Nuclear Medicine, AOU Città della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 14, 10129, Turin, Italy.
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy.
| | - Lorenzo Bianchi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
- Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco Borghesi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
- Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Polverari
- Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Farolfi
- Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Schiavina
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
- Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
- Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Castellucci
- Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Zattoni F, Incerti E, Dal Moro F, Moschini M, Castellucci P, Panareo S, Picchio M, Fallanca F, Briganti A, Gallina A, Fanti S, Schiavina R, Brunocilla E, Rambaldi I, Lowe V, Karnes JR, Evangelista L. 18F-FDG PET/CT and Urothelial Carcinoma: Impact on Management and Prognosis-A Multicenter Retrospective Study. Cancers (Basel) 2019; 11:cancers11050700. [PMID: 31137599 PMCID: PMC6562413 DOI: 10.3390/cancers11050700] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 04/11/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives: To evaluate the ability of 18F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict survivorship of patients with bladder cancer (BC) and/or upper urinary tract carcinoma (UUTC). Materials: Data from patients who underwent FDG PET/CT for suspicion of recurrent urothelial carcinoma (UC) between 2007 and 2015 were retrospectively collected in a multicenter study. Disease management after the introduction of FDG PET/CT in the diagnostic algorithm was assessed in all patients. Kaplan-Meier and log-rank analysis were computed for survival assessment. A Cox regression analysis was used to identify predictors of recurrence and death, for BC, UUTC, and concomitant BC and UUTC. Results: Data from 286 patients were collected. Of these, 212 had a history of BC, 38 of UUTC and 36 of concomitant BC and UUTC. Patient management was changed in 114/286 (40%) UC patients with the inclusion of FDG PET/CT, particularly in those with BC, reaching 74% (n = 90/122). After a mean follow-up period of 21 months (Interquartile range: 4–28 mo.), 136 patients (47.4%) had recurrence/progression of disease. Moreover, 131 subjects (45.6%) died. At Kaplan-Meier analyses, patients with BC and positive PET/CT had a worse overall survival than those with a negative scan (log-rank < 0.001). Furthermore, a negative PET/CT scan was associated with a lower recurrence rate than a positive examination, independently from the primary tumor site. At multivariate analysis, in patients with BC and UUTC, a positive FDG PET/CT resulted an independent predictor of disease-free and overall survival (p < 0,01). Conclusions: FDG PET/CT has the potential to change patient management, particularly for patients with BC. Furthermore, it can be considered a valid survival prediction tool after primary treatment in patients with recurrent UC. However, a firm recommendation cannot be made yet. Further prospective studies are necessary to confirm our findings.
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Affiliation(s)
- Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
- Urology Unit, Academical Medical Centre Hospital, 33100 Udine, Italy.
| | - Elena Incerti
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
- Urology Unit, Academical Medical Centre Hospital, 33100 Udine, Italy.
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Paolo Castellucci
- Department of Nuclear Medicine, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy.
| | - Stefano Panareo
- Nuclear Medicine Unit, Diagnostic Imaging e Laboratory Medicine Department, University Hospital of Ferrara, 44121 Ferrara, Italy.
| | - Maria Picchio
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Federico Fallanca
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
- Vita-Salute San Raffaele University, 20132 Milan, Italy.
| | - Andrea Gallina
- Department of Urology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Stefano Fanti
- Department of Nuclear Medicine, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy.
| | - Riccardo Schiavina
- Department of Urology, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy.
| | - Eugenio Brunocilla
- Department of Urology, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy.
| | - Ilaria Rambaldi
- Nuclear Medicine Unit, Diagnostic Imaging e Laboratory Medicine Department, University Hospital of Ferrara, 44121 Ferrara, Italy.
| | - Val Lowe
- Division of Nuclear Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | - Laura Evangelista
- Nuclear Medicine and Molecular Imaging Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy.
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43
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Bianchi L, Schiavina R, Borghesi M, Ceci F, Angiolini A, Chessa F, Droghetti M, Bertaccini A, Manferrari F, Marcelli E, Cochetti G, Porreca A, Castellucci P, Fanti S, Brunocilla E. How does
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Ga‐prostate‐specific membrane antigen positron emission tomography/computed tomography impact the management of patients with prostate cancer recurrence after surgery? Int J Urol 2019; 26:804-811. [DOI: 10.1111/iju.14012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/07/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Lorenzo Bianchi
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - Riccardo Schiavina
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - Marco Borghesi
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - Francesco Ceci
- Metropolitan Nuclear Medicine S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
- Ahmanson Translational Imaging Division Department of Molecular and Medical Pharmacology University of California at Los Angeles Los Angeles California USA
| | - Andrea Angiolini
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
| | - Francesco Chessa
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
| | - Matteo Droghetti
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
| | - Alessandro Bertaccini
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - Fabio Manferrari
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - Emanuela Marcelli
- Department of Specialist, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
- Metropolitan Nuclear Medicine S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
- Ahmanson Translational Imaging Division Department of Molecular and Medical Pharmacology University of California at Los Angeles Los Angeles California USA
- Laboratory of Bioengineering Department of Experimental Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences Institute of Urological Andrological Surgery and Minimally Invasive Techniques Perugia Italy
| | | | - Paolo Castellucci
- Metropolitan Nuclear Medicine S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
| | - Stefano Fanti
- Metropolitan Nuclear Medicine S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
| | - Eugenio Brunocilla
- Department of Urology S. Orsola‐Malpighi University Hospital University of Bologna Bologna Italy
- Department of Specialist, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
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44
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Polverari G, Ceci F, Calderoni L, Cervati V, Farolfi A, Castellucci P, Fanti S. Male Breast Cancer Detected by 68Ga-PSMA-11 PET/CT in a Patient With Prostate Cancer With Pelvic Lymph Node Metastasis. Clin Genitourin Cancer 2019; 17:154-156. [DOI: 10.1016/j.clgc.2018.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 01/22/2023]
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45
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Zagni F, Lima G, Farina A, Castellucci P, Savoia F, Kirikova A, Wendler T, Fanti S, Marengo M. 361. A new therapy with 188Re for non-melanoma skin cancers. First experiences. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.369] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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46
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Ceci F, Polverari G, Calais J, Castellucci P. The influence of PSA flare in mCRPC patients treated with alpha-emitting radiopharmaceuticals. Eur J Nucl Med Mol Imaging 2018; 45:2253-2255. [DOI: 10.1007/s00259-018-4162-5] [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: 11/28/2022]
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47
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Angelini A, Castellucci P, Ceci F. Future Perspective of the Application of Positron Emission Tomography-Computed Tomography-MR Imaging in Musculoskeletal Disorders. PET Clin 2018; 14:183-191. [PMID: 30420219 DOI: 10.1016/j.cpet.2018.08.012] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is the imaging method of choice in sarcoma patients. PET may help in diagnosis, grading, staging, biopsy guidance, monitoring response to therapy, restaging for recurrence, and prognosis. 18F-FDG-PET/MRI combines the higher tissue contrast of MRI in the study of soft-tissue lesions and the peculiarities of PET imaging that allow the characterization of tissues. The use of 18F-FDG-PET/MRI in these patients has reduces the radiation dose, which is of great importance, particularly in children. Data support the routine use of 18F-FDG-PET either using CT or MRI in patients with sarcoma.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via 8 Febbraio 1848, 2, 35122 Padova, Italy
| | - Paolo Castellucci
- Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via massarenti 9, 40138, Bologna, Italy
| | - Francesco Ceci
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California at Los Angeles (UCLA), 200 Medical Plaza, Suite B114, Los Angeles CA 90095, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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48
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Collamati F, Bocci V, Castellucci P, De Simoni M, Fanti S, Faccini R, Giordano A, Maccora D, Mancini-Terracciano C, Marafini M, Mirabelli R, Morganti S, Schiavina R, Scotognella T, Traini G, Solfaroli Camillocci E. Radioguided surgery with β radiation: a novel application with Ga 68. Sci Rep 2018; 8:16171. [PMID: 30385885 PMCID: PMC6212404 DOI: 10.1038/s41598-018-34626-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/23/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022] Open
Abstract
Radio Guided Surgery is a technique helping the surgeon in the resection of tumors: a radiolabeled tracer is administered to the patient before surgery and then the surgeon evaluates the completeness of the resection with a handheld detector sensitive to emitted radiation. Established methods rely on γ emitting tracers coupled with γ detecting probes. The efficacy of this technique is however hindered by the high penetration of γ radiation, limiting its applicability to low background conditions. To overtake such limitations, a novel approach to RGS has been proposed, relying on β− emitting isotopes together with a dedicated β probe. This technique has been proved to be effective in first ex-vivo trials. We discuss in this paper the possibility to extend its application cases to 68Ga, a β+ emitting isotope widely used today in nuclear medicine. To this aim, a retrospective study on 45 prostatic cancer patients was performed, analysing their 68Ga-PSMA PET images to asses if the molecule uptake is enough to apply this technique. Despite the expected variability both in terms of SUV (median 4.1, IQR 3.0–6.1) and TNR (median 9.4, IQR 5.2–14.6), the majority of cases have been found to be compatible with β-RGS with reasonable injected activity and probing time (5 s).
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Affiliation(s)
| | - Valerio Bocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Paolo Castellucci
- Medicina Nucleare Metropolitana, Bld 30, AOU Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Micol De Simoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy.,Dip. Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | - Stefano Fanti
- Medicina Nucleare Metropolitana, Bld 30, AOU Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Riccardo Faccini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - Alessandro Giordano
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Daria Maccora
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Michela Marafini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Museo Storico della Fisica e Centro Studi e Ricerche E.Fermi, Roma, Italy
| | - Riccardo Mirabelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - Silvio Morganti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | | | | | - Giacomo Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - Elena Solfaroli Camillocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy.,Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy.,Scuola di Specializzazione in Fisica Medica, Sapienza Università di Roma, Roma, Italy
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49
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Ceci F, Castellucci P, Graziani T, Farolfi A, Fonti C, Lodi F, Fanti S. 68Ga-PSMA-11 PET/CT in recurrent prostate cancer: efficacy in different clinical stages of PSA failure after radical therapy. Eur J Nucl Med Mol Imaging 2018; 46:31-39. [DOI: 10.1007/s00259-018-4189-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/03/2018] [Indexed: 01/29/2023]
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50
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Schiavina R, Chessa F, Borghesi M, Gaudiano C, Bianchi L, Corcioni B, Castellucci P, Ceci F, Ceravolo I, Barchetti G, Del Monte M, Campa R, Catalano C, Panebianco V, Nanni C, Fanti S, Minervini A, Porreca A, Brunocilla E. State-of-the-art imaging techniques in the management of preoperative staging and re-staging of prostate cancer. Int J Urol 2018; 26:18-30. [DOI: 10.1111/iju.13797] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/18/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Riccardo Schiavina
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Francesco Chessa
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Marco Borghesi
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Caterina Gaudiano
- Radiology Unit; Department of Diagnostic Medicine and Prevention; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Lorenzo Bianchi
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Beniamino Corcioni
- Radiology Unit; Department of Diagnostic Medicine and Prevention; St. Orsola-Malpighi Hospital; Bologna Italy
| | - Paolo Castellucci
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Francesco Ceci
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
- Ahmanson Translational Imaging Division; Department of Molecular and Medical Pharmacology; University of California at Los Angeles; Los Angeles California USA
| | - Isabella Ceravolo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Giovanni Barchetti
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Maurizio Del Monte
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Riccardo Campa
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Carlo Catalano
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Valeria Panebianco
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology; Sapienza University of Rome; Rome Italy
| | - Cristina Nanni
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Stefano Fanti
- Metropolitan Nuclear Medicine; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Andrea Minervini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery; Abano Terme Hospital; Abano Terme Italy
| | - Eugenio Brunocilla
- Department of Urology; University of Bologna; St. Orsola-Malpighi Hospital; Bologna Italy
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