Research Articles (Nuclear Medicine)

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Efficacy, safety, and patient reported outcomes of rhenium-skin cancer therapy for non-melanoma skin cancer : 1-year results from the EPIC-skin study
(Elsevier, 2025-07) Cardaci, Giuseppe; Baxi, Siddhartha; Vohra, Saima; Allison, Cody; Hong, Angela; Mulholland, Nicola; Sathekge, Mike Machaba; Mokoala, Kgomotso; Heuschkel, Martin; Tietze, Julia; Mirzaei, Siroos; Dahlhoff, Gerhard
PURPOSE : Rhenium-skin cancer therapy (SCT) is an innovative, noninvasive radionuclide treatment for nonmelanoma skin cancer (NMSC), which is administered in a single outpatient treatment session. A global, multicenter, single-arm, phase 4 post-marketing clinical study was established to evaluate efficacy, safety, cosmesis, and patient-reported outcomes of OncoBeta rhenium-SCT for NMSC. This report details scheduled 12-month interim results, including toxicity, cosmesis, and patient-reported outcomes. METHODS AND MATERIALS : Eligible patients had biopsy-proven stage I or II basal cell carcinoma or squamous cell carcinoma (SCC) lesions ≤3 mm deep and ≤8 cm 2 in area. Patients were administered rhenium-SCT as a resin applied to adhesive foil affixed to the lesion/s, with a dose of 50 Gy to the deepest point. As per the treatment protocol, efficacy was assessed using modified Response Evaluation Criteria in Solid Tumors criteria after 12 months, with planned primary endpoint measuring complete response scheduled for 24 months. Secondary endpoints included patient-reported quality of life (Skin Cancer Index) treatment comfort, cosmesis (visual assessment scale; 1: poor -10: not visible), and toxicity (CTCAE v5.0). RESULTS : Response rates for 185 treated lesions from 140 patients were 94.1% (174/185) complete response, and 3.2% (6/185) partial response. The remaining lesions were classified as progressive or stable disease in 2.2% (4/185) and 0.5% (1/185), respectively. Quality of life improved by a mean 10.55 (95% CI, 3.79, 17.31) points (100-point scale) from baseline. No patients reported pain or discomfort during treatment. Most patients (88%, 129/147) developed radiation dermatitis as expected, which was predominantly grade 1 or 2 in severity and resolved rapidly. The most common 12-month toxicity in patients was grade 1 hypopigmentation (60.4%; 78/129), while there was no incidence of grade 3 or 4 toxicities at this time. Patient- and clinician-reported cosmesis visual assessment scale outcomes were broadly favorable at 8.1 and 7.7, respectively (10-point scale). CONCLUSIONS : This 12-month interim analysis of EPIC-Skin indicates rhenium-SCT is an effective and well-tolerated treatment for shallow basal cell carcinoma and SCC lesions, yielding favorable safety, cosmesis, and patient-satisfaction outcomes. These outcomes underscore the utility of rhenium-SCT as a single-session, noninvasive treatment for NMSC, offering a safe, effective, and efficient alternative to surgery for patients with functional or cosmetic considerations, and/or comorbidities.
Non-FDG hypoxia tracers
(Elsevier, 2024-11) Mokoala, Kgomotso M.G.; Sathekge, Mike Machaba; Kgomotso.mokoala@up.ac.za
Hypoxia plays a critical role in tumor biology, influencing cancer progression, treatment resistance, and patient prognosis. While 18-Fluorine fluoredeoxyglucose ([18F]F-FDG) PET imaging has been the standard for metabolic assessment, its limitations in accurately depicting hypoxic tumor regions necessitate the exploration of non-FDG hypoxia tracers. This review aims to evaluate emerging non-FDG radiotracers, such as nitroimidazole derivatives, copper-based agents, gallium-based agents and other innovative compounds, highlighting their mechanisms of action, biodistribution, and clinical applications. We will discuss the advantages and challenges associated with hypoxia imaging, as well as recent advancements in imaging techniques that enhance the assessment of tumor hypoxia. By synthesizing current research, this review seeks to provide insights into the potential of non-FDG hypoxia tracers for improving cancer diagnosis, treatment planning, and monitoring, ultimately contributing to more personalized and effective cancer care.
Visualisation of in vivo protein synthesis during mycobacterial infection through [68Ga]Ga-DOTA-puromycin µPET/MRI
(Nature Research, 2024-08-20) Eigner, Sebastian; Kleynhans, Janke; Vera, Dennis R. Beckford; Sathekge, Mike Machaba; Henke, Katerina Eigner; Ebenhan, Thomas
Radiolabelled puromycin analogues will allow the quantification of protein synthesis through nuclear medicine-based imaging. A particularly useful application could be the non-invasive longitudinal visualisation of mycobacterial activity through direct quantification of puromycin binding. This study assesses the value of [68Ga]Ga-DOTA-puromycin in the visualisation of mycobacteria through positron emission tomography combined with magnetic resonance imaging (µPET/MRI). The radiopharmaceutical was produced by previously published and validated methods. [68Ga]Ga-DOTA-Puromycin imaging was performed on severe immunodeficient mice infected with Bacille Calmette-Guérin-derived M. Bovis (BCG). Acute and chronic infection stages were examined by µPET/MRI. A follow-up group of animals acted as controls (animals bearing S. aureus-derived infection and sterile inflammation) to assess tracer selectivity. [68Ga]Ga-DOTA-puromycin-µPET/MRI images revealed the acute, widespread infection within the right upper shoulder and armpit. Also, [68Ga]Ga-DOTA-puromycin signal sensitivity measured after a 12-week period was lower than that of [18F]FDG-PET in the same animals. A suitable correlation between normalised uptake values (NUV) and gold standard histopathological analysis confirms accurate tracer accumulation in viable bacteria. The radiopharmaceutical showed infection selectivity over inflammation but accumulated in both M. Bovis and S. Aureus, lacking pathogen specificity. Overall, [68Ga]Ga-DOTA-puromycin exhibits potential as a tool for non-invasive protein synthesis visualization, albeit without pathogen selectivity.
Gallium-68-NODASA-functionalized D-lysine radiosynthesis and first-line in vitro characterization-a potential PET imaging agent for infection
(South African Chemical Institute, 2025-03) Gouws, Christiaan A.; Naicker, Tricia; Duvenhage, Janie; De la Torre, Beatriz G.; Albericio, Fernando; Kruger, Hendrik G.; Marjanovic-Painter, Biljana; Mdanda, Sipho; Zeevaart, Jan Rijn; Ebenhan, Thomas; Govender, Thavendran; thomas.ebenhan@up.ac.za
The advancement of new Positron Emission Tomography (PET) radiotracers for differentiating bacterial infections from sterile inflammation is essential for accurate diagnosis and treatment monitoring. D-amino acid-based probes have shown promise for bacterial imaging due to their selective peptidoglycan incorporation. However, host enzyme-mediated racemization of radiolabeled D-amino acids and limited tissue penetration of fluorescence signal of fluorescent D-amino acids limits their in vivo performance. Herein, we report the successful chemical synthesis, optimized radiosynthesis, and the required first-line in vitro characterization of [68Ga]Ga-NDL-1 (NDL = NODASA D-lysine; NODASA = 1,4,7-triazacyclononane-1-succinic acid-4,7-diacetic acid) (the L-isomeric compound, aka. [68Ga]Ga-NLL-1 was evaluated in parallel as the control). Robust radiolabeling was achieved within 60 minutes using the optimized radiolabeling method, featuring the consistent production of very good radiochemical yields (81.7 ± 3.2%), apparent molar activities (17.1 ± 0.8 GBq/μmol) and with excellent radiochemical purities (97.7 ± 0.5%), free of 68Ga-colloids; therefore, deemed suitable for future intravenous administration and micro-PET imaging applications. [68Ga]Ga-NDL-1 was highly stable during prolonged incubation in the presence of 1000-times excess of EDTA (>93%) as well as a during a 2-hour exposure to plasma (>97%). [68Ga]Ga-NLL-1 and [68Ga]Ga-NDL-1 showed minimal overall blood cell binding (<12%) or plasma protein binding (<15%). Results justify further investigation of [68Ga]Ga-NDL-1 as a potential PET imaging agent of infection.
Optimizing theranostics chatbots with context-augmented large language models
(Ivyspring International Publisher, 2025-04) Koller, Pia; Clement, Christoph; Van Eijk, Albert; Seifert, Robert; Zhang, Jingjing; Prenosil, George; Sathekge, Mike Machaba; Herrmann, Ken; Baum, Richard; Weber, Wolfgang A.; Rominger, Axel; Shi, Kuangyu
IINTRODUCTION : Nuclear medicine theranostics is rapidly emerging, as an interdisciplinary therapy option with multi-dimensional considerations. Healthcare Professionals do not have the time to do in depth research on every therapy option. Personalized Chatbots might help to educate them. Chatbots using Large Language Models (LLMs), such as ChatGPT, are gaining interest addressing these challenges. However, chatbot performances often fall short in specific domains, which is critical in healthcare applications. METHODS : This study develops a framework to examine the use of contextual augmentation to improve the performance of medical theranostic chatbots to create the first theranostic chatbot. Contextual augmentation involves providing additional relevant information to LLMs to improve their responses. We evaluate five state-of-the-art LLMs on questions translated into English and German. We compare answers generated with and without contextual augmentation, where the LLMs access pre-selected research papers via Retrieval Augmented Generation (RAG). We are using two RAG techniques: Naïve RAG and Advanced RAG. RESULTS : A user study and LLM-based evaluation assess answer quality across different metrics. Results show that Advanced RAG techniques considerably enhance LLM performance. Among the models, the best-performing variants are CLAUDE 3 OPUS and GPT-4O. These models consistently achieve the highest scores, indicating robust integration and utilization of contextual information. The most notable improvements between Naive RAG and Advanced RAG are observed in the GEMINI 1.5 and COMMAND R+ variants. CONCLUSION : This study demonstrates that contextual augmentation addresses the complexities inherent in theranostics. Despite promising results, key limitations include the biased selection of questions focusing primarily on PRRT, the need for comprehensive context documents. Future research should include a broader range of theranostics questions, explore additional RAG methods and aim to compare human and LLM evaluations more directly to enhance LLM performance further.
Comparing 68Ga-Pentixafor,18F-FDG PET/CT and chemokine receptor 4 immunohistochemistry staining in breast cancer : a prospective cross sectional study
(MDPI, 2025-03) Hadebe, Bawinile; Harry, Lerwine; Gabela, Lerato; Nxasana, Thembelihle; Ndlovu, Nontobeko; Pillay, Venesen; Masikane, Siphelele; Patel, Maryam; Mpanya, Dineo; Buccimaza, Ines; Msimang, Mpumelelo; Aldous, Colleen; Sathekge, Mike Machaba; Vorster, Mariza
BACKGROUND : CXCR4 is a chemokine receptor that is frequently overexpressed in invasive breast cancer and plays a major role in tumor proliferation, aggressiveness and metastasis. The aim of this prospective study was to establish the value of CXCR4-directed PET imaging in patients with breast cancer using the novel CXCR4-targeted PET probe 68Ga-Pentixafor by comparing it with 18F-FDG PET/CT (n = 40). MATERIALS AND METHODS : In this prospective cross-sectional study, fifty-one patients with breast cancer aged 36–81 (median (Q1-Q3) 51 (42.5–63)), n = 47 (92%) with initially diagnosed and n = 4 (8%) patients with recurrent breast cancer, underwent CXCR4-targeted PET imaging using 68Ga-Pentixafor. Maximum standardized uptake values (SUVmax), total lesion glycolysis (TLG) or total lesion uptake (TLU), metabolic tumor volume (MTV) and tumor-to-background ratios (TBR) of tumor lesions were measured and correlated with pathological prognostic factors, molecular subtypes and CXCR4 immunohistochemistry (IHC) staining. 18F-FDG PET/CT images were available in 40 of 51 cases (82%) and were compared semi-quantitatively. The patients were followed up for a median of 11 months (range 4–80 months) to determine whether CXCR4 expression correlated with survival. RESULTS : 68Ga-Pentixafor-PET/CT was visually positive in 49/51 (96%) of the cases; in addition, [18F]FDG demonstrated a higher SUVmax compared to 68Ga-Pentixafor. The mean SUVmax was 7.26 ± 2.84 and 18.8 ± 9.1 for 68Ga-Pentixafor and [18F]FDG, respectively. Thirty-seven percent (18/51) of patients had triple-negative breast cancer and 25/51 (49%) had estrogen receptor (ER+) disease. There was a statistically significant correlation between tumor grade, proliferative index (Ki-67) and SUVmax obtained from 68Ga-Pentixafor PET p = 0.002. There was no correlation between the SUVmax obtained from 68Ga-Pentixafor and PET molecular subtypes, estrogen receptor (ER), progesterone receptor (PR) or human epidermal growth factor receptor 2 (HER2) status; however, triple-negative breast cancers had more avid 68Ga-Pentixafor accumulation compared to luminals A and B. The median (Q1–Q3) 68Ga-Pentixafor TLU was significantly higher in HIV-positive (376 (219–881)) compared to HIV-negative (174 (105–557)) breast cancer patients. CONCLUSIONS : In conclusion, 68Ga-Pentixafor had a sensitivity of 96% and a specificity of 100% for detecting primary breast cancer; in addition, 68Ga-Pentixafor exhibited significantly higher uptake in patients with higher tumor grade, high proliferative index and triple-negative breast cancer (TNBC), as well as HIV-infected breast cancer patients, highlighting the potential clinical utility and prognostic role of CXCR4-targeted PET imaging in aggressive breast cancer. Notably, 68Ga-Pentixafor complements 18F-FDG by detecting more metastasis in the brain and the skull where FDG has limitations, while 18F-FDG remains superior for detecting skeletal metastasis. Future research should further explore the potential of CXCR4-targeted PET imaging in selecting patients with triple-negative breast cancer and high-grade breast cancer who may benefit from CXCR4-targeted therapies, particularly in the context of HIV co-infection.
Evaluating Xerostomia as a side effect of [255Ac]Ac-PSMA therapy in prostate cancer : a systematic review and meta-analysis
(Springer, 2025-07) Al-Ibraheem, Akram; Moghrabi, Serin; Sathekge, Mike Machaba; Abdlkadir, Ahmed Saad
Please read abstract in the article.
Evaluation of [68Ga]Ga-DOTA-AeK as a potential imaging tool for PET imaging of cell wall synthesis in bacterial infections
(MDPI, 2024-09) Koatale, Palesa Caroline; Welling, Mick M.; Mdanda, Sipho; Mdlophane, Amanda; Takyi-Williams, John; Durandt, Chrisna; Van den Bout, Iman; Cleeren, Frederik; Sathekge, Mike Machaba; Ebenhan, Thomas; thomas.ebenhan@up.ac.za
Please read abstract in article.
[18F]F-poly(ADP-Ribose) polymerase inhibitor radiotracers for imaging PARP expression and their potential clinical applications in oncology
(MDPI, 2024-06-11) Ndlovu, Honest; Lawal, Ismaheel Opeyemi; Mdanda, Sipho; Kgatle, Mankgopo; Mokoala, K.M.G. (Kgomotso); Al-Ibraheem, Akram; Sathekge, Mike Machaba; mike.sathekge@up.ac.za
Including poly(ADP-ribose) polymerase (PARP) inhibitors in managing patients with inoperable tumors has significantly improved outcomes. The PARP inhibitors hamper single-strand deoxyribonucleic acid (DNA) repair by trapping poly(ADP-ribose)polymerase (PARP) at sites of DNA damage, forming a non-functional “PARP enzyme–inhibitor complex” leading to cell cytotoxicity. The effect is more pronounced in the presence of PARP upregulation and homologous recombination (HR) deficiencies such as breast cancer-associated gene (BRCA1/2). Hence, identifying HR-deficiencies by genomic analysis—for instance, BRCA1/2 used in triple-negative breast cancer—should be a part of the selection process for PARP inhibitor therapy. Published data suggest BRCA1/2 germline mutations do not consistently predict favorable responses to PARP inhibitors, suggesting that other factors beyond tumor mutation status may be at play. A variety of factors, including tumor heterogeneity in PARP expression and intrinsic and/or acquired resistance to PARP inhibitors, may be contributing factors. This justifies the use of an additional tool for appropriate patient selection, which is noninvasive, and capable of assessing whole-body in vivo PARP expression and evaluating PARP inhibitor pharmacokinetics as complementary to the currently available BRCA1/2 analysis. In this review, we discuss [18F]Fluorine PARP inhibitor radiotracers and their potential in the imaging of PARP expression and PARP inhibitor pharmacokinetics. To provide context we also briefly discuss possible causes of PARP inhibitor resistance or ineffectiveness. The discussion focuses on TNBC, which is a tumor type where PARP inhibitors are used as part of the standard-of-care treatment strategy.
Time for action : actinium-225 PSMA-targeted alpha therapy for metastatic prostate cancer – a systematic review and meta-analysis
(Ivyspring International Publisher, 2025-02) Ninatti, Gaia; Scilipoti, Pietro; Pini, Cristiano; Barletta, Francesco; Longoni, Mattia; Gelardi, Fabrizia; Sollini, Martina; Gandaglia, Giorgio; Sathekge, Mike Machaba; Montorsi, Francesco; Chiti, Arturo; Briganti, Alberto
RATIONALE : Metastatic prostate cancer in the castration-resistant (mCRPC) setting remains challenging to treat. Prostate-specific membrane antigen (PSMA)-targeted alpha therapy (TAT) is emerging as a promising option. We aimed to systematically review the efficacy and safety of PSMA-TAT in patients with prostate cancer. METHODS : A comprehensive search of PubMed/MEDLINE and EMBASE databases was conducted up to October 2024, adhering to the PRISMA guidelines. Selected studies were original research articles evaluating the efficacy and/or safety of PSMA-TAT including at least 10 patients. The outcomes measured included any prostate-specific antigen (PSA) response, ≥50% PSA reduction (PSA50), progression-free survival (PFS), overall survival (OS), and adverse events. PSA50 was pooled using a random-effects model, incorporating individual patient data on PSA50 and previous lines of treatment. RESULTS : Eighteen studies involving 1,155 patients met the inclusion criteria. The majority included heavily pre-treated patients. The most commonly employed radiopharmaceutical was [225Ac]Ac-PSMA-617, in 15 studies. The pooled PSA50 response rate was 65% [95% Confidence interval (CI), 57-72%] with a moderate level of heterogeneity (I² = 81.17%, p < 0.001). Pooled response rates in patients who received none, one, and more than one prior line of treatment were 82% (95% CI, 73-90%), 72% (95% CI, 56-85%), and 55% (95% CI, 48-63%), respectively. PFS varied from 3 to 15 months, and OS from 8 to 31 months. Adverse events were predominantly mild (grades 1-2); severe adverse events (≥ grade 3) included anaemia (11%) and thrombocytopenia (6%). CONCLUSION : PSMA-TAT holds promising efficacy and an acceptable safety profile for treating metastatic prostate cancer. Randomised controlled trials are needed to optimise treatment protocols toward the implementation of PSMA-TAT into clinical practice.
68Ga radiolabeling of NODASA-functionalized phage display-derived peptides for prospective assessment as Tuberculosis-specific PET radiotracers
(Wiley, 2024-09) Gouws, Christiaan A.; Naicker, Tricia; De la Torre, Beatriz G.; Albericio, Fernando; Duvenhage, Janie; Kruger, Hendrik G.; Marjanovic-Painter, Biljana; Mdanda, Sipho; Zeevaart, Jan Rijn; Ebenhan, Thomas; Govender, Thavendran; thomas.ebenhan@up.ac.za
Please read abstract in article.
Imaging molecular targets and metabolic pathways in breast cancer for improved clinical management: current practice and future perspectives
(MDPI, 2024-02) Ndlovu, Honest; Lawal, Ismaheel Opeyemi; Mokoala, K.M.G. (Kgomotso); Sathekge, Mike Machaba
Breast cancer is the most frequently diagnosed cancer and leading cause of cancer-related deaths worldwide. Timely decision-making that enables implementation of the most appropriate therapy or therapies is essential for achieving the best clinical outcomes in breast cancer. While clinicopathologic characteristics and immunohistochemistry have traditionally been used in decisionmaking, these clinical and laboratory parameters may be difficult to ascertain or be equivocal due to tumor heterogeneity. Tumor heterogeneity is described as a phenomenon characterized by spatial or temporal phenotypic variations in tumor characteristics. Spatial variations occur within tumor lesions or between lesions at a single time point while temporal variations are seen as tumor lesions evolve with time. Due to limitations associated with immunohistochemistry (which requires invasive biopsies), whole-body molecular imaging tools such as standard-of-care [18F]FDG and [18F]FES PET/CT are indispensable in addressing this conundrum. Despite their proven utility, these standardof- care imaging methods are often unable to image a myriad of other molecular pathways associated with breast cancer. This has stimulated interest in the development of novel radiopharmaceuticals targeting other molecular pathways and processes. In this review, we discuss validated and potential roles of these standard-of-care and novel molecular approaches. These approaches’ relationships with patient clinicopathologic and immunohistochemical characteristics as well as their influence on patient management will be discussed in greater detail. This paper will also introduce and discuss the potential utility of novel PARP inhibitor-based radiopharmaceuticals as non-invasive biomarkers of PARP expression/upregulation.
Real world experience with [99mTc]Tc-HYNIC-iPSMA SPECT prostate cancer detection : interim results from the global NOBLE registry
(SpringerOpen, 2024-12) Tually, Pete; Quinto, Virginia G.; Omar, Yehia; Novruzov, Fuad; Yudistiro, Ryan; Sathekge, Mike Machaba; Currie, Geoffrey; Galette, Paul; Patel, Neel; Brown, Tracey; Bolland, Gabriel; Lo Bue, Rebecca; Cade, David
Please read abstract in article.
Ionising radiation exposure-induced regulation of selected biomarkers and their impact in cancer and treatment
(Frontiers Media, 2024-10) Mzizi, Yonwaba; Mbambara, Saidon; Moetlhoa, Boitumelo; Mahapane, Johncy; Mdanda, Sipho; Sathekge, Mike Machaba; Kgatle, Mankgopo
Ionising radiation (IR) is a form of energy that travels as electromagnetic waves or particles. While it is vital in medical and occupational health settings, IR can also damage DNA, leading to mutations, chromosomal aberrations, and transcriptional changes that disrupt the functions of certain cell regulators, genes, and transcription factors. These disruptions can alter functions critical for cancer development, progression, and treatment response. Additionally, IR can affect various cellular proteins and their regulators within different cell signalling pathways, resulting in physiological changes that may promote cancer development, progression, and resistance to treatment. Understanding these impacts is crucial for developing strategies to mitigate the harmful effects of IR exposure and improve cancer treatment outcomes. This review focuses on specific genes and protein biomarkers regulated in response to chronic IR exposure, and how their regulation impacts disease onset, progression, and treatment response.
EANM/SNMMI guideline/procedure standard for [18F]FDG hybrid PET use in infection and inflammation in adults v2.0
(Springer, 2025-01) Abikhzer, Gad; Treglia, Giorgio; Pelletier‑Galarneau, Matthieu; Buscombe, John Richard; Chiti, Arturo; Dibble, Elizabeth H.; Glaudemans, Andor W.J.M.; Palestro, Christopher J.; Sathekge, Mike Machaba; Signore, Alberto; Jamar, Francois; Israel, Ora; Gheysens, Olivier; mike.sathekge@up.ac.za
Please read abstract in article.
Recently developed radiopharmaceuticals for bacterial infection imaging
(SpringerOpen, 2024) Kahts, Maryke; Summers, Beverley; Gutta, Aadil; Pilloy, Wilfrid; Ebenhan, Thomas
Infection remains a major cause of morbidity and mortality, regardless of advances in antimicrobial therapy and improved knowledge of microorganisms. With the major global threat posed by antimicrobial resistance, fast and accurate diagnosis of infections, and the reliable identification of intractable infection, are becoming more crucial for effective treatment and the application of antibiotic stewardship. Molecular imaging with the use of nuclear medicine allows early detection and localisation of infection and infammatory processes, as well as accurate monitoring of treatment response. There has been a continuous search for more specific radiopharmaceuticals to be utilised for infection imaging. This review summarises the most prominent discoveries in specifically bacterial infection imaging agents over the last five years, since 2019. MAIN BODY: Some promising new radiopharmaceuticals evaluated in patient studies are reported here, including radiolabelled bacterial siderophores like [ 68Ga]Ga-DFO-B, radiolabelled antimicrobial peptide/peptide fragments like [ 68Ga]Ga-NOTA-UBI29-41, and agents that target bacterial synthesis pathways (folic acid and peptidoglycan) like [ 11C]para-aminobenzoic acid and D-methyl-[11C]-methionine, with clinical trials underway for [ 18F]fuorodeoxy-sorbitol, as well as for 11C- and 18F-labelled trimethoprim. CONCLUSION: It is evident that a great deal of effort has gone into the development of new radiopharmaceuticals for infection imaging over the last few years, with remarkable progress in preclinical investigations. However, translation to clinical trials, and eventually clinical Nuclear Medicine practice, is apparently slow. It is the authors’ opinion that a more structured and harmonised preclinical setting and well-designed clinical investigations are the key to reliably evaluate the true potential of the newly proposed infection imaging agents.
Chemokine receptor-4 targeted PET/CT imaging with 68Ga-Pentixafor in head and neck cancer—a comparison with 18F-FDG and CXCR4 immunohistochemistry
(MDPI, 2024-06) Hadebe, Bawinile; Harry, Lerwine; Gabela, Lerato; Masikane, Siphelele; Patel, Maryam; Zwane, Sizwe; Pillay, Venesen; Bipath, Presha; Cebekhulu, Nonhlanhla; Nyakale, Nozipho E.; Ramdass, Prathima; Msimang, Mpumelelo; Aldous, Colleen; Sathekge, Mike Machaba; Vorster, Mariza
Please read abstract in article.
Highlighting new research trends on Zirconium-89 radiopharmaceuticals beyond antibodies
(Elsevier, 2024-11) Duvenhage, Janie; Kahts, Maryke; Summers, Beverley; Zeevaart, Jan Rijn; Ebenhan, Thomas
Please read abstract in the article.
Prostate-specific membrane antigen-positron emission tomography-guided radiomics and machine learning in prostate carcinoma
(MDPI, 2024-10) Maes, Justine; Gesquière, Simon; Maes, Alex; Sathekge, Mike Machaba; Van de Wiele, Christophe
Positron emission tomography (PET) using radiolabeled prostate-specific membrane antigen targeting PET-imaging agents has been increasingly used over the past decade for imaging and directing prostate carcinoma treatment. Here, we summarize the available literature data on radiomics and machine learning using these imaging agents in prostate carcinoma. Gleason scores derived from biopsy and after resection are discordant in a large number of prostate carcinoma patients. Available studies suggest that radiomics and machine learning applied to PSMA-radioligand avid primary prostate carcinoma might be better performing than biopsy-based Gleason-scoring and could serve as an alternative for non-invasive GS characterization. Furthermore, it may allow for the prediction of biochemical recurrence with a net benefit for clinical utilization. Machine learning based on PET/CT radiomics features was also shown to be able to differentiate benign from malignant increased tracer uptake on PSMA-targeting radioligand PET/CT examinations, thus paving the way for a fully automated image reading in nuclear medicine. As for prediction to treatment outcome following 177Lu-PSMA therapy and overall survival, a limited number of studies have reported promising results on radiomics and machine learning applied to PSMA-targeting radioligand PET/CT images for this purpose. Its added value to clinical parameters warrants further exploration in larger datasets of patients.
Radiotherapy and theranostics : a Lancet Oncology Commission
(Elsevier, 2024-11) Abdel-Wahab, May; Giammarile, Francesco; Carrara, Mauro; Paez, Diana; Hricak, Hedvig; Ayati, Nayyereh; Li, Jing Jing; Mueller, Malina; Aggarwal, Ajay; Al-Ibraheem, Akram; Alkhatib, Sondos; Atun, Rifat; Bello, Abubakar; Berger, Daniel; Delgado Bolton, Roberto C.; Buatti, John M.; Burt, Graeme; Bjelac, Olivera Ciraj; Cordero-Mendez, Lisbeth; Dosanjh, Manjit; Eichler, Thomas; Fidarova, Elena; Gondhowiardjo, Soehartati; Gospodarowicz, Mary; Grover, Surbhi; Hande, Varsha; Harsdorf-Enderndorf, Ekaterina; Herrmann, Ken; Hofman, Michael S.; Holmberg, Ola; Jaffray, David; Knoll, Peter; Kunikowska, Jolanta; Lewis, Jason S.; Lievens, Yolande; Mikhail-Lette, Miriam; Ostwald, Dennis; Palta, Jatinder R.; Peristeris, Platon; Rosa, Arthur A.; Salem, Soha Ahmed; Dos Santos, Marcos A.; Sathekge, Mike Machaba; Shrivastava, Shyam Kishore; Titovich, Egor; Urbain, Jean-Luc; Vanderpuye, Verna; Wahl, Richard L.; Yu, Jennifer S.; Zaghloul, Mohamed Saad; Zhu, Hongcheng; Scott, Andrew M.
Following on from the 2015 Lancet Oncology Commission on expanding global access to radiotherapy, Radiotherapy and theranostics: a Lancet Oncology Commission was created to assess the access and availability of radiotherapy to date and to address the important issue of access to the promising field of theranostics at a global level. A marked disparity in the availability of radiotherapy machines between high-income countries and low-income and middle-income countries (LMICs) has been identified previously and remains a major problem. The availability of a suitably trained and credentialled workforce has also been highlighted as a major limiting factor to effective implementation of radiotherapy, particularly in LMICs. We investigated initiatives that could mitigate these issues in radiotherapy, such as extended treatment hours, hypofractionation protocols, and new technologies. The broad implementation of hypofractionation techniques compared with conventional radiotherapy in prostate cancer and breast cancer was projected to provide radiotherapy for an additional 2·2 million patients (0·8 million patients with prostate cancer and 1·4 million patients with breast cancer) with existing resources, highlighting the importance of implementing new technologies in LMICs. A global survey undertaken for this Commission revealed that use of radiopharmaceutical therapy—other than 131I—was highly variable in high-income countries and LMICs, with supply chains, workforces, and regulatory issues affecting access and availability. The capacity for radioisotope production was highlighted as a key issue, and training and credentialling of health professionals involved in theranostics is required to ensure equitable access and availability for patient treatment. New initiatives—such as the International Atomic Energy Agency's Rays of Hope programme—and interest by international development banks in investing in radiotherapy should be supported by health-care systems and governments, and extended to accelerate the momentum generated by recognising global disparities in access to radiotherapy. In this Commission, we propose actions and investments that could enhance access to radiotherapy and theranostics worldwide, particularly in LMICs, to realise health and economic benefits and reduce the burden of cancer by accessing these treatments.

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