Submit to Cancers Review for Cancers Propose a Special Issue

Journal Menu

Journal Browser

Radionuclide Therapy and Hybrid Imaging in Oncology

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Published Papers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 20508

Share This Special Issue

Special Issue Editors

Dr. Amir Sabet

E-Mail Website
Guest Editor

Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
Interests: targeted radionuclide therapy (RLT, PRRT, and SIRT); molecular imaging

Prof. Dr. Frank Grünwald

E-Mail Website
Guest Editor

Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
Interests: thyroid cancer; prostate cancer; neuroimaging; theranostics

Special Issue Information

Dear Colleagues,

This Special Issue addresses the role of radionuclides for diagnostic and therapeutic purposes in oncology. A variety of radionuclides have been introduced for hybrid imaging combining molecular imaging (i.e., single photon emission computed tomography (SPECT) or positron emission tomography (PET)) with data from morphological imaging (i.e., computer tomography (CT) and magnetic resonance imaging (MRI)). ¹⁸F-FDG PET/CT is the most frequently used form of hybrid imaging and has formed an integral part of diagnostic workup in oncology for several years.

The introduction of novel radiotracers in clinical practice for visualizing more specific characteristics of cancer cells such as the abundance of somatostatin receptors (SSTR) on the cell membranes of neuroendocrine tumors (NETs) and the overexpression of prostate-specific membrane antigen (PSMA) by prostate cancer cells has further expanded the scope of hybrid imaging and contributed to a better understanding of radionuclide therapies targeting the same molecules with therapeutic a- and b-emitting radiopharmaceuticals. Hybrid imaging can also facilitate dosimetric measurements allowing better patient selection as well as safe and personalized treatment concepts. Pretherapeutic imaging with ¹²⁴I-PET/CT has been useful in patients with thyroid cancer undergoing radioiodine therapy. Promising results have also been reported using pre- and post-therapeutic SPECT/CT with ^99mTc and ⁹⁰Y for dosimetry in the radioembolization of hepatic tumors. Despite several studies declaring PET/MRI to be superior in certain settings, its limited availability and the challenges surrounding MRI-based attenuation correction have, to date, hindered its routine clinical use.

Radionuclide therapy has experienced a breakthrough in recent years. The success of internationally conducted prospective studies with strictly defined treatment protocols has led to the acceptance of radionuclide therapy as an effective targeted anti-cancer treatment. In the NETTER-1 study, peptide receptor radionuclide therapy (PRRT) with ¹⁷⁷Lu-DOTATATE yielded a significant improvement in the median progression-free survival of patients with metastatic NET. In the VISION trial, radioligand therapy with ¹⁷⁷Lu-PSMA-617 proved to be a promising life-prolonging option for patients with metastatic castration-resistant prostate cancer (mCRPC). The TheraP trial suggested ¹⁷⁷Lu-PSMA-617 as a safe alternative to cabazitaxel with fewer significant adverse events. Future investigation may be directed at the individualization of radionuclide therapy to maximize patients’ benefit.

Dr. Amir Sabet
Prof. Dr. Frank Grünwald
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

radioligand therapy (RLT)
177Lu-PSMA-617
peptide receptor radionuclide therapy (PRRT)
177Lu-DOTATATE
selective internal radiation therapy (SIRT)
radioembolization (RE)
radioiodine therapy (RIT)
PET/CT
PET/MRI

Published Papers (10 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Review

11 pages, 2712 KiB

Open AccessArticle

Intermittent Radioligand Therapy with ¹⁷⁷Lu-PSMA-617 for Oligometastatic Castration-Resistant Prostate Cancer

by Nicolai Mader, Christina Schoeler, Niloufar Pezeshkpour, Konrad Klimek, Daniel Groener, Christian Happel, Nikolaos Tselis, Philipp Mandel, Frank Grünwald and Amir Sabet

Cancers 2023, 15(18), 4605; https://doi.org/10.3390/cancers15184605 - 17 Sep 2023

Cited by 1 | Viewed by 1288

Abstract

¹⁷⁷Lu-PSMA-617 radioligand therapy (¹⁷⁷Lu-PSMA-RLT) in patients with metastatic castration-resistant prostate cancer (mCRPC) currently consists of 4–6 cycles of 6.0–7.4 GBq of ¹⁷⁷Lu-PSMA-617 each every 6–8 weeks. While safety and efficacy could be demonstrated in larger prospective trials irrespective of the tumor burden at ¹⁷⁷Lu-PSMA RLT initiation, increased renal absorbed doses due to a reduced tumor sink effect in early responding, oligometastatic mCRPC patients pose difficulties. Response-adapted, dose distributing, intermittent treatment with up to six cycles has not been routinely performed, due to concerns about the potential loss of disease control. Treatment was discontinued in 19 early-responding patients with oligometastatic tumor burden after two (IQR 2–3) cycles of ¹⁷⁷Lu-PSMA-RLT and 6.5 ± 0.7 GBq per cycle and resumed upon ⁶⁸Ga-PSMA-11-PET/CT-based progression (according to the PCWG3 criteria). Subsequent treatment breaks were imposed if a PSMA-based imaging response could be achieved. A total of five (IQR 3–6) cycles reaching a cumulative activity of 32 ± 11 GBq were applied. A routine blood work-up including blood counts and liver and renal function was measured throughout the ¹⁷⁷Lu-PSMA-RLT and follow-up to grade toxicity according to CTCAE v5.0 criteria. Survival outcome was calculated based on the Kaplan–Meier method. In total, treatment-free periods of 9 (IQR 6–17) cumulative months and the application of ¹⁷⁷Lu-PSMA-RLT cycles over 16 (IQR 9–22) months could be achieved. Fifteen (84%) patients responded to subsequent cycles after the first treatment break and in 7/19 (37%) patients, intermittent ¹⁷⁷Lu-PSMA-RLT consisted of ≥2 treatment breaks. The median PFS was 27 months (95% CI: 23–31) and overall survival was 45 months (95% CI: 28–62). No grade ≥3 hematological or renal toxicities could be observed during the 45 ± 21 months of follow-up. The cumulative mean renal absorbed dose was 16.7 ± 8.3 Gy and 0.53 ± 0.21 Gy/GBq. Intermittent radioligand therapy with ¹⁷⁷Lu-PSMA-617 is feasible in early-responding patients with oligometastatic disease. A late onset of progression after subsequent cycles and the absence of significant toxicity warrants further investigation of the concept of intermittent treatment in selected patients. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

13 pages, 7842 KiB

Open AccessArticle

Impact of [¹⁷⁷Lu]Lu-PSMA-617 Radioligand Therapy on Reference Organ Uptake Assessed by [⁶⁸Ga]Ga-PSMA-11-PET/CT

by Daniel Groener, Jennifer Wichert, Magdalena Adams, Nicolai Mader, Konrad Klimek, Christina Nguyen Ngoc, Justus Baumgarten, Christian Happel, Philipp Mandel, Felix K. H. Chun, Nikolaos Tselis, Frank Grünwald and Amir Sabet

Cancers 2023, 15(15), 3878; https://doi.org/10.3390/cancers15153878 - 30 Jul 2023

Cited by 2 | Viewed by 1056

Abstract

This study aims to assess the change in uptake to reference organs, including the liver, parotid and salivary glands after radioligand therapy (RLT) with [¹⁷⁷Lu]Lu-PSMA-617 in relation to pretreatment imaging metrics. Eighty-five patients with mCRPC underwent [⁶⁸Ga]Ga-PSMA-11 PET/CT imaging prior to (pre RLT PET) and after (post RLT PET) a median of 3 (IQR 2-6) RLT cycles with [¹⁷⁷Lu]Lu-PSMA-617. PSMA-positive tumor burden was stratified into 4 groups based on modified PROMISE criteria (oligofocal, multifocal, disseminated, diffuse). Uptake (SUV_mean, SUV_max) in liver tissue, parotid and submandibular glands was measured. A control group was established with 54 patients who had received two separate PET acquisitions following the same protocol (PET1, PET2) within 12 months for localized or oligofocal prostate cancer without RLT in the interim. Baseline uptake values (SUV_mean, SUV_max) in parotid (10.8 ± 3.2, 16.8 ± 5.4) and submandibular glands (11.3 ± 2.8, 18.1 ± 4.7) are 2-fold compared to liver uptake (4.9 ± 1.4, 7.7 ± 2.0), with no significant change between PET 1 and PET 2 in the control group. In the RLT group, increasing tumor burden class is significantly associated with decreasing uptake in the liver (p = 0.013), parotid (p < 0.001) and submandibular glands (p < 0.001); this tumor sink effect by respective tumor burden is widely maintained after RLT (p = 0.011, p < 0.001, p < 0.001). RLT has a significant impact on salivary gland uptake with decreasing values per patient in all groups of disease burden change (up to −30.4% in submandibular glands, p < 0.001), while liver tissue shows rising values in patients with declining tumor burden throughout RLT (+18.6%, p = 0.020). Uptake in liver tissue and salivary glands on [⁶⁸Ga]Ga-PSMA-11 PET/CT imaging is inversely related to tumor burden prior to and following RLT with [¹⁷⁷Lu]Lu-PSMA-617. Per patient, salivary gland uptake is further reduced throughout RLT independently from tumor burden, while changes in liver uptake remain burden-dependent. Liver and salivary gland uptake-derived metrics and segmentation thresholds may thus be of limited value when used as reference for response assessment to RLT. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

16 pages, 3901 KiB

Open AccessArticle

Baseline [⁶⁸Ga]Ga-PSMA-11 PET/CT before [¹⁷⁷Lu]Lu-PSMA-617 Radioligand Therapy: Value of PSMA-Uptake Thresholds in Predicting Targetable Lesions

by Daniel Groener, Sina Schneider, Justus Baumgarten, Christian Happel, Konrad Klimek, Nicolai Mader, Christina Nguyen Ngoc, Jennifer Wichert, Philipp Mandel, Nikolaos Tselis, Frank Grünwald and Amir Sabet

Cancers 2023, 15(2), 473; https://doi.org/10.3390/cancers15020473 - 12 Jan 2023

Cited by 4 | Viewed by 1920

Abstract

Baseline uptake on prostate-specific membrane antigen (PSMA)-targeted imaging is a prerequisite for radioligand therapy (RLT) with [¹⁷⁷Lu]Lu-PSMA-617. This study aims to quantify lesion-based response to RLT in relation to pretreatment standard molecular imaging metrics derived from [⁶⁸Ga]Ga-PSMA-11 PET/CT. Sixty-one patients with mCRPC underwent [⁶⁸Ga]Ga-PSMA-11 PET/CT imaging before and after a median of 4 (IQR 2–6) RLT cycles. Maximum and mean standardized uptake values (SUV_max, SUV_mean), as well as tumor-to-liver ratio (TLR), were assessed. A median of 12 (IQR 7–17) lesions was analyzed per patient, resulting in a total of 718 lesions. Lesions with ≥30% SUV_max decline or falling below the blood pool uptake were considered responsive; ≥30% SUV_max increase marked lesion progression. Additionally, 4-point visual scoring was performed according to E-PSMA consensus. In total, 550/718 (76.6%) lesions responded to RLT, including 389/507 (76.7%) bone metastases and 143/181 (79.0%) lymph node metastases. Baseline SUV_max, SUV_mean, and TLR values were associated with lesion response by a moderate but significant correlation (r_s = 0.33, p < 0.001, r_s = 0.32, p < 0.001, and r_s = 0.31, p < 0.001, respectively). For the classification of lesion progression based on baseline PSMA uptake, receiver operating characteristics (ROC) found SUV_max, SUV_mean, and TLR to have comparable discriminatory value (AUC 0.85, 0.87, and 0.83). Of 42 tumor sites with baseline uptake below the liver (V-score < 2), 19/42 (45.2%) were responsive, 9/42 (21.4%) were stable, and 14/42 (33.3%) showed progression, leaving liver uptake a threshold with low prognostic value for the identification of RLT-refractory lesions (PPV 33%). This was observed accordingly for various liver uptake-based thresholds, including TLR < 1.5, <2.0 with a PPV at 24%, 20%, respectively. Standard uptake parameters quantified by routine baseline [⁶⁸Ga]Ga-PSMA-11 PET/CT are moderately associated with post-treatment lesion response to [¹⁷⁷Lu]Lu-PSMA-617. Commonly applied liver-based uptake thresholds have limited value in predicting refractory lesions at individual tumor sites. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

17 pages, 3329 KiB

Open AccessArticle

Intra-Individual Comparison of ¹²⁴I-PET/CT and ¹²⁴I-PET/MR Hybrid Imaging of Patients with Resected Differentiated Thyroid Carcinoma: Aspects of Attenuation Correction

by Hong Grafe, Maike E. Lindemann, Manuel Weber, Julian Kirchner, Ina Binse, Lale Umutlu, Ken Herrmann and Harald H. Quick

Cancers 2022, 14(13), 3040; https://doi.org/10.3390/cancers14133040 - 21 Jun 2022

Cited by 1 | Viewed by 1325

Abstract

Background: This study evaluates the quantitative differences between 124-iodine (I) positron emission tomography/computed tomography (PET/CT) and PET/magnetic resonance imaging (PET/MR) in patients with resected differentiated thyroid carcinoma (DTC). Methods: N = 43 ¹²⁴I PET/CT and PET/MR exams were included. CT-based attenuation correction (AC) in PET/CT and MR-based AC in PET/MR with bone atlas were compared concerning bone AC in the head-neck region. AC-map artifacts (e.g., dentures) were noted. Standardized uptake values (SUV) were measured in lesions in each PET data reconstruction. Relative differences in SUV_mean were calculated between PET/CT and PET/MR with bone atlas. Results: Overall, n = 111 ¹²⁴I-avid lesions were detected in all PET/CT, while n = 132 lesions were detected in PET/MR. The median in SUV_mean for n = 98 congruent lesions measured in PET/CT was 12.3. In PET/MR, the median in SUV_mean was 16.6 with bone in MR-based AC. Conclusions: ¹²⁴I-PET/CT and ¹²⁴I-PET/MR hybrid imaging of patients with DTC after thyroidectomy provides overall comparable quantitative results in a clinical setting despite different patient positioning and AC methods. The overall number of detected ¹²⁴I-avid lesions was higher for PET/MR compared to PET/CT. The measured average SUV_mean values for congruent lesions were higher for PET/MR. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

7 pages, 2774 KiB

Open AccessCommunication

Addition of Standard Enzalutamide Medication Shows Synergistic Effects on Response to [¹⁷⁷Lu]Lu-PSMA-617 Radioligand Therapy in mCRPC Patients with Imminent Treatment Failure—Preliminary Evidence of Pilot Experience

by Florian Rosar, Hanna Bader, Mark Bartholomä, Stephan Maus, Caroline Burgard, Johannes Linxweiler, Fadi Khreish and Samer Ezziddin

Cancers 2022, 14(11), 2691; https://doi.org/10.3390/cancers14112691 - 29 May 2022

Cited by 7 | Viewed by 1928

Abstract

Well-received strong efficacy of prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) does not prevent patients from either early or eventual disease progression under this treatment. In this study, we investigated co-medication with enzalutamide as a potential re-sensitizer for PSMA-RLT in patients with imminent treatment failure on standard ¹⁷⁷Lu-based PSMA-RLT. Ten mCRPC patients who exhibited an insufficient response to conventional [¹⁷⁷Lu]Lu-PSMA-617 RLT received oral medication of enzalutamide 160 mg/d as an adjunct to continued PSMA-RLT. Prostate-specific antigen (PSA) and standard toxicity screening lab work-up were performed to assess the treatment efficacy and safety in these individuals. The mean PSA increase under PSMA-RLT before starting the re-sensitizing procedure was 22.4 ± 26.5%. After the introduction of enzalutamide medication, all patients experienced a PSA decrease, –43.4 ± 20.0% and –48.2 ± 39.0%, after one and two cycles of enzalutamide-augmented PSMA-RLT, respectively. A total of 70% of patients (7/10) experienced partial remission, with a median best PSA response of –62%. Moreover, 5/6 enzalutamide-naïve patients and 2/4 patients who had previously failed enzalutamide exhibited a partial remission. There was no relevant enzalutamide-induced toxicity observed in this small cohort. This pilot experience suggests the synergistic potential of adding enzalutamide to PSMA-RLT derived from the intra-individual comparison of ¹⁷⁷Lu-based PSMA-RLT ± enzalutamide. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

11 pages, 1995 KiB

Open AccessArticle

Upregulation of PSMA Expression by Enzalutamide in Patients with Advanced mCRPC

by Florian Rosar, Robert Neher, Caroline Burgard, Johannes Linxweiler, Mathias Schreckenberger, Manuela A. Hoffmann, Mark Bartholomä, Fadi Khreish and Samer Ezziddin

Cancers 2022, 14(7), 1696; https://doi.org/10.3390/cancers14071696 - 26 Mar 2022

Cited by 13 | Viewed by 2514

Abstract

In this study, we investigated upregulation of prostate-specific membrane antigen (PSMA) by enzalutamide in a cohort (n = 30) of patients with advanced metastatic castration-resistant prostate cancer (mCRPC). Patients were examined by [⁶⁸Ga]Ga-PSMA-11 PET/CT pre- and post-enzalutamide medication (mean 13 ± 7 days). Imaging results were compared based on quantification of whole-body PSMA tumor burden: total lesion PSMA (TLP) and normalized TLP values to liver (TLP-LR) and to parotid gland (TLP-PR). In addition, lesion-based analyses were performed. The median (mean) increases in TLP, TLP-LR and TLP-PR after enzalutamide medication were 10.1% (20.2%), 29.5% (34.8%) and 27.6% (24.4%), respectively. These increases were statistically significant (p = 0.002, p < 0.001, and p < 0.001), while prostate-specific antigen (PSA) serum values did not change significantly (p = 0.483). The increase was independent of prior patient exposure to enzalutamide. SUV_max increased substantially (>10%) in 49.6% of target lesions. The relative change was significantly higher in the subgroup of lesions with SUV_max < 10 (p < 0.001). In conclusion, short-term enzalutamide medication significantly increases PSMA expression in patients with mCRPC, irrespective of prior enzalutamide exposure. The relative PSMA upregulation effect seems to be more pronounced in lesions with only moderate baseline PSMA expression. Enzalutamide may provide a potential enhancer medication for PSMA-targeted radioligand therapy. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

27 pages, 3859 KiB

Open AccessArticle

Radioembolization of Hepatocellular Carcinoma with ⁹⁰Y Glass Microspheres: No Advantage of Voxel Dosimetry with Respect to Mean Dose in Dose–Response Analysis with Two Radiological Methods

by Chiara Romanò, Stefania Mazzaglia, Marco Maccauro, Carlo Spreafico, Alejandro Gabutti, Gabriele Maffi, Carlo Morosi, Tommaso Cascella, Marta Mira, Maria Chiara De Nile, Gianluca Aliberti, Giovanni Argiroffi, Valentina Fuoco, Sherrie Bhoori, Consuelo Zanette, Alfonso Marchianò, Ettore Seregni, Vincenzo Mazzaferro and Carlo Chiesa

Cancers 2022, 14(4), 959; https://doi.org/10.3390/cancers14040959 - 15 Feb 2022

Cited by 10 | Viewed by 2166

Abstract

In this confirmatory study, we tested if a calculation that included the non-uniformity of dose deposition through a voxel-based dosimetric variable Ψ was able to improve the dose–response agreement with respect to the mean absorbed dose D. We performed dosimetry with ^99mTc-MAA SPECT/CT and ⁹⁰Y-PET/CT in 86 patients treated 8 instead of 4 days after the reference date with 2.8 times more ⁹⁰Y glass microspheres/GBq than in our previous study. The lesion-by-lesion response was assessed with the mRECIST method and with an experimental densitometric criterion. A total of 106 lesions were studied. Considering Ψ as a prognostic response marker, having no Ψ provided a significantly higher AUC than D. The correlation, t-test, and AUC values were statistically significant only with the densitometric method and only with post-therapy dosimetry. In comparison with our previous study, the dose–response correlation and AUC values were poorer (maximum r = 0.43, R² = 0.14, maximal AUC = 0.71), and the efficacy at a high dose did not reach 100%. The expected advantages of voxel dosimetry were nullified by the correlation between any Ψ and D due to the limited image spatial resolution. The lower AUC and efficacy may be explained by the mega-clustering effect triggered by the higher number of microspheres/GBq injected on day 8. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

13 pages, 2427 KiB

Open AccessArticle

Hematotoxicity and Nephrotoxicity in Prostate Cancer Patients Undergoing Radioligand Therapy with [¹⁷⁷Lu]Lu-PSMA I&T

by Philipp E. Hartrampf, Franz-Xaver Weinzierl, Sebastian E. Serfling, Martin G. Pomper, Steven P. Rowe, Takahiro Higuchi, Anna Katharina Seitz, Hubert Kübler, Andreas K. Buck and Rudolf A. Werner

Cancers 2022, 14(3), 647; https://doi.org/10.3390/cancers14030647 - 27 Jan 2022

Cited by 17 | Viewed by 3153

Abstract

(1) Background: Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT) has shown remarkable results in patients with advanced prostate cancer. We aimed to evaluate the toxicity profile of the PSMA ligand [¹⁷⁷Lu]Lu-PSMA I&T. (2) Methods: 49 patients with metastatic, castration-resistant prostate cancer treated with at least three cycles of [¹⁷⁷Lu]Lu-PSMA I&T were evaluated. Prior to and after RLT, we compared leukocytes, hemoglobin, platelet counts, and renal functional parameters (creatinine, eGFR, n = 49; [^99mTc]-MAG3-derived tubular extraction rate (TER), n = 42). Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 and KDIGO Society. To identify predictive factors, we used Spearman’s rank correlation coefficient. (3) Results: A substantial fraction of the patients already showed impaired renal function and reduced leukocyte counts at baseline. Under RLT, 11/49 (22%) patients presented with nephrotoxicity CTCAE I or II according to creatinine, but 33/49 (67%) according to eGFR. Only 5/42 (13%) showed reduced TER, defined as <70% of the age-adjusted mean normal values. Of all renal functional parameters, absolute changes of only 2% were recorded. CTCAE-based re-categorization was infrequent, with creatinine worsening from I to II in 2/49 (4.1%; GFR, 1/49 (2%)). Similar results were recorded for KDIGO (G2 to G3a, 1/49 (2%); G3a to G3b, 2/49 (4.1%)). After three cycles, follow-up eGFR correlated negatively with age (r = −0.40, p = 0.005) and the eGFR change with Gleason score (r = −0.35, p < 0.05) at baseline. Leukocytopenia CTCAE II occurred only in 1/49 (2%) (CTCAE I, 20/49 (41%)) and CTCAE I thrombocytopenia in 7/49 (14%), with an absolute decrease of 15.2% and 16.6% for leukocyte and platelet counts. Anemia CTCAE II occurred in 10/49 (20%) (CTCAE I, 36/49 (73%)) with a decrease in hemoglobin of 4.7%. (4) Conclusions: After PSMA-targeted therapy using [¹⁷⁷Lu]Lu-PSMA I&T, no severe (CTCAE III/IV) toxicities occurred, thereby demonstrating that serious adverse renal or hematological events are unlikely to be a frequent phenomenon with this agent. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

11 pages, 1150 KiB

Open AccessArticle

Outcome and Safety after 103 Radioembolizations with Yttrium-90 Resin Microspheres in 73 Patients with Unresectable Intrahepatic Cholangiocarcinoma—An Evaluation of Predictors

by Karolin J. Paprottka, Franziska Galiè, Michael Ingrisch, Tobias Geith, Harun Ilhan, Andrei Todica, Marlies Michl, Jonathan Nadjiri and Philipp M. Paprottka

Cancers 2021, 13(21), 5399; https://doi.org/10.3390/cancers13215399 - 27 Oct 2021

Cited by 17 | Viewed by 1786

Abstract

Trans-arterial radioembolization (TARE) is increasingly evaluated for unresectable intrahepatic cholangiocarcinoma (ICC). Not all ICC patients benefit equally well from TARE. Therefore, we sought to evaluate variables predicting progression-free survival (PFS) and overall survival (OS). Patients with non-resectable ICC underwent TARE and were treated with 90Y resin microspheres. Baseline characteristics, biochemical/clinical toxicities, and response were examined for impact on PFS and OS. A total of 103 treatments were administered to 73 patients without major complications or toxicity. Mean OS was 18.9 months (95% confidence intervals (CI); 13.9–23.9 months). Mean and median PFS were 10.1 months (95% CI; 7.9–12.2) and 6.4 months (95% CI; 5.20–7.61), respectively. Median OS and PFS were significantly prolonged in patients with baseline cholinesterase (CHE) ≥ 4.62 kU/L (OS: 14.0 vs. 5.5 months; PFS: 6.9 vs. 3.2 months; p < 0.001). Patients with a tumor burden ≤ 25% had a significantly longer OS (15.2 vs. 6.6 months; p = 0.036). Median PFS was significantly longer for patients with multiple TARE cycles (24.4 vs. 5.8 months; p = 0.04). TARE is a considerable and safe option for unresectable ICC. CA-19-9, CHE, and tumor burden have predictive value for survival in patients treated with TARE. Multiple TARE treatments might further improve survival; this has to be confirmed by further studies. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

► Show Figures

Figure 1

Review

Jump to: Research

16 pages, 333 KiB

Open AccessReview

Individualization of Radionuclide Therapies: Challenges and Prospects

by Hanna Piwowarska-Bilska, Sara Kurkowska and Bozena Birkenfeld

Cancers 2022, 14(14), 3418; https://doi.org/10.3390/cancers14143418 - 14 Jul 2022

Cited by 8 | Viewed by 2087

Abstract

The article presents the problems of clinical implementation of personalized radioisotope therapy. The use of radioactive drugs in the treatment of malignant and benign diseases is rapidly expanding. Currently, in the majority of nuclear medicine departments worldwide, patients receive standard activities of therapeutic radiopharmaceuticals. Intensively conducted clinical trials constantly provide more evidence of a close relationship between the dose of radiopharmaceutical absorbed in pathological tissues and the therapeutic effect of radioisotope therapy. Due to the lack of individual internal dosimetry (based on the quantitative analysis of a series of diagnostic images) before or during the treatment, only a small fraction of patients receives optimal radioactivity. The vast majority of patients receive too-low doses of ionizing radiation to the target tissues. This conservative approach provides “radiation safety” to healthy tissues, but also delivers lower radiopharmaceutical activity to the neoplastic tissue, resulting in a low level of response and a higher relapse rate. The article presents information on the currently used radionuclides in individual radioisotope therapies and on radionuclides newly introduced to the therapeutic market. It discusses the causes of difficulties with the implementation of individualized radioisotope therapies as well as possible changes in the current clinical situation. Full article

(This article belongs to the Special Issue Radionuclide Therapy and Hybrid Imaging in Oncology)

Show export options Show export options

Select all

Export citation of selected articles as:

Displaying articles 1-10

Journal Menu

Journal Browser

Radionuclide Therapy and Hybrid Imaging in Oncology

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (10 papers)

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI