Radioguidance that makes use of β-emitting radionuclides is gaining in popularity and could have potential to strengthen the range of existing radioguidance techniques. While there is a strong tendency to develop new PET radiotracers, due to favorable imaging characteristics and the success of theranostics research, there are practical challenges that need to be overcome when considering use of β-emitters for surgical radioguidance. In this position paper, the EANM identifies the possibilities and challenges that relate to the successful implementation of β-emitters in surgical guidance, covering aspects related to instrumentation, radiation protection, and modes of implementation.
In the HD15 trial of the German Hodgkin Study Group, the negative predictive value (NPV) of positron emission tomography (PET) using [(18)F]-fluorodeoxyglucose in advanced-stage Hodgkin lymphoma (HL) was evaluated. A total of 817 patients were enrolled and randomly assigned to receive BEACOPP-based chemotherapy. After completion of chemotherapy, residual disease measuring more than or equal to 2.5 cm in diameter was assessed by PET in 311 patients. The NPV of PET was defined as the proportion of PET(-) patients without progression, relapse, or irradiation within 12 months after PET review panel. The progression-free survival was 96% for PET(-) patients (95% confidence interval [CI], 94%-99%) and 86% for PET(+) patients (95% CI, 78%-95%, P = .011). The NPV for PET in this analysis was 94% (95% CI, 91%-97%). Thus, consolidation radiotherapy can be omitted in PET(-) patients with residual disease without increasing the risk for progression or early relapse compared with patients in complete remission. The impact of this finding on the overall survival at 5 years must be awaited. Until then, response adapted therapy guided by PET for HL patients seems to be a promising approach that should be further evaluated in clinical trials. This trial is registered at http://isrctn.org study as #ISRCTN32443041.
- MeSH
- Bleomycin administration & dosage MeSH
- Cyclophosphamide administration & dosage MeSH
- Adult MeSH
- Doxorubicin administration & dosage MeSH
- Etoposide administration & dosage MeSH
- Fluorodeoxyglucose F18 * administration & dosage MeSH
- Hodgkin Disease * drug therapy mortality radiography MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Adolescent MeSH
- Positron-Emission Tomography * methods MeSH
- Predictive Value of Tests MeSH
- Prednisone administration & dosage MeSH
- Disease-Free Survival MeSH
- Procarbazine administration & dosage MeSH
- Antineoplastic Combined Chemotherapy Protocols * administration & dosage MeSH
- Radiopharmaceuticals * administration & dosage MeSH
- Neoplasm, Residual MeSH
- Risk Factors MeSH
- Vincristine administration & dosage MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Publication type
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
