Radionuclide Therapy and Hybrid Imaging in Oncology

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

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