Publications by authors named "Oreste Bagni"

52 Publications

Usefulness of PET/CT with F-FDG in Patients with Differentiated Thyroid Carcinoma after Radioiodine Therapy: An Italian Multicenter Study.

Diagnostics (Basel) 2021 Jul 14;11(7). Epub 2021 Jul 14.

Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy.

Background: our aim was to assess the diagnostic performance and clinical impact of F-FDG PET/CT in patients with differentiated thyroid carcinoma (DTC), previously treated with surgery and radioiodine therapy (RAI).

Methods: patients subjected to F-FDG PET/CT for suspected DTC recurrence in three Italian nuclear medicine units were evaluated. Two different clinical settings were identified: clinical setting 1 included patients (n = 40) that were enrolled according to the American Thyroid Association guidelines (i.e., negative 1-WBS and Tg level > 10 ng/mL); and clinical setting 2, that encompassed subjects (n = 26) with serum Tg ≤ 10 ng/mL but morphological findings suspected of relapse. PET/CT's impact was scored as significant if it provided an indication for surgery, or led to a novel therapeutic decision.

Results: In total, 51/66 patients (77.3%) were F-FDG positive, while 15 (22.7%) were negative. PET/CT showed an overall sensitivity and specificity of 84.4% and 75%, respectively. Sensitivity was higher in clinical setting 1 (89.1%) as compared to clinical setting 2 (76.1%), although this difference was not statistically significant ( = 0.83). PET/CT influenced clinical management in 28 cases (42.4%), without a significant difference between the 2 groups of patients ( = 0.6).

Conclusions: our preliminary data, although limited by the retrospective nature of the study and possible selection bias, suggest that F-FDG PET/CT may be utilized for the detection of DTC recurrence in different clinical settings, with a meaningful impact on clinical management.
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http://dx.doi.org/10.3390/diagnostics11071264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306511PMC
July 2021

Long-Term Maintained Response to Selective Internal Radiation Therapy in an Oligometastatic Uveal Melanoma Patient Treated with Concomitant Anti-PD-1 Therapy.

Life (Basel) 2021 Jul 14;11(7). Epub 2021 Jul 14.

Dermatology Unit "Daniele Innocenzi", "A. Fiorini" Hospital, Via Firenze, 1, 04019 Terracina, Italy.

Uveal melanoma (UM) is a primary neoplasm of the eye arising from the melanocytes residing in the iris, ciliary body or choroid. It is the most frequent intraocular malignancy and often determines metastases at distant sites, with a peculiar tropism for the liver. Metastatic UM has a poor prognosis, as any treatment affects the natural course of this fatal disease. Herein, we report a case of a UM metastatic to the liver in a 54 year-old female patient, initially treated with nivolumab without success. The patient was then scheduled for selective internal radiation therapy (SIRT) while continuing immunotherapy. This combination led to a complete and durable response and the patient is currently free of disease, two years after the diagnosis of the hepatic metastases. The association between SIRT and immunotherapy (IT) has very promising perspectives for metastatic UM, especially considering the disappointing or contradictory results of classic chemotherapies, IT alone and targeted therapies. Furthermore, this combination has been shown to have a good security profile. However, further studies are needed to confirm the efficacy of associating SIRT and IT and to clarify some unsolved problems, such as the timing of administration of these two therapies.
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http://dx.doi.org/10.3390/life11070692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307638PMC
July 2021

Sunitinib Treatment for Advanced Paraganglioma: Case Report of a Novel SDHD Gene Mutation Variant and Systematic Review of the Literature.

Front Oncol 2021 17;11:677983. Epub 2021 Jun 17.

Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy.

Background: Paragangliomas (PGLs) are neuroendocrine neoplasms arising from chromaffin cells of sympathetic or parasympathetic paraganglia. Systemic therapies have been used only in metastatic PGLs. Antiangiogenic agents, such as sunitinib, could be a viable therapeutic choice in the subgroup of patients with -positive PGLs. We describe the case of a man with Familial Paraganglioma Syndrome type 1 (FPGL) related to a novel mutation in gene treated with sunitinib. Furthermore, we performed a systematic review of the literature aimed to address the following question: is sunitinib treatment effective in patients with advanced/progressive/metastatic PGL?

Methods: We performed a data search using MEDLINE, Cochrane Library, and Scopus between April 2019 and September 2020. We included studies reporting data on clinical or biological characteristics, or clinical outcomes of patients with PGLs treated with sunitinib.

Results: The search leaded to the selection of 25 publications. Data from case reports and case series showed that disease control rate (DCR = stable disease + partial response + complete response) was achieved in 34.7% of cases under sunitinib treatment. In 39% of patients DCR was followed by progressive disease (PD) or tumor relapse, 26.1% patients showed PD. Data from clinical trials showed that DCR was 83%, and the median progression free survival was 13.4 months.

Discussion: Data from the present literature review suggested that sunitinib could be a viable therapeutic option in advanced/progressive/metastatic inoperable PGLs. However, further trials on the efficacy of sunitinib in FPGL and sporadic PGL are needed.
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http://dx.doi.org/10.3389/fonc.2021.677983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247584PMC
June 2021

Letter to the Editor Regarding "F-DOPA Positron Emission Tomography in Medulloblastoma: 2 Case Reports".

World Neurosurg 2021 06;150:253-254

UOC Territorial Oncology AUSL Latina-CdS Aprilia-University of Rome "Sapienza", Rome, Italy.

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http://dx.doi.org/10.1016/j.wneu.2021.04.011DOI Listing
June 2021

Stunning Response with Low-Dose Enzalutamide after Abiraterone Acetate Failure in a Patient Diagnosed with Metastatic Castration-Resistant Prostate Cancer: A Case Report.

Case Rep Oncol 2021 Jan-Apr;14(1):634-640. Epub 2021 Mar 31.

UOC of Oncology - ASL Latina - Distretto 1, University of Rome "Sapienza", Aprilia, Italy.

We report a case of an elderly patient with metastatic castration-resistant prostate cancer, initially treated with abiraterone acetate (1,000 mg/day) combined with LH-RH antagonist, prednisone (10 mg/day), and zoledronic acid to manage bone metastases. In consideration of his poor performance status, radiological and biochemical progression of the disease, we decided to switch abiraterone to enzalutamide (160 mg/day). Due to adverse events, we reduced enzalutamide to a dose of 80 mg/day. Currently, the disease is under control despite the use of a low dose of enzalutamide.
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http://dx.doi.org/10.1159/000514979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077606PMC
March 2021

Prognostic and Theranostic Applications of Positron Emission Tomography for a Personalized Approach to Metastatic Castration-Resistant Prostate Cancer.

Int J Mol Sci 2021 Mar 16;22(6). Epub 2021 Mar 16.

Department of Nuclear Medicine, "Santa Maria Goretti" Hospital, Via Antonio Canova, 04100 Latina, Italy.

Metastatic castration-resistant prostate cancer (mCRPC) represents a condition of progressive disease in spite of androgen deprivation therapy (ADT), with a broad spectrum of manifestations ranging from no symptoms to severe debilitation due to bone or visceral metastatization. The management of mCRPC has been profoundly modified by introducing novel therapeutic tools such as antiandrogen drugs (i.e., abiraterone acetate and enzalutamide), immunotherapy through sipuleucel-T, and targeted alpha therapy (TAT). This variety of approaches calls for unmet need of biomarkers suitable for patients' pre-treatment selection and prognostic stratification. In this scenario, imaging with positron emission computed tomography (PET/CT) presents great and still unexplored potential to detect specific molecular and metabolic signatures, some of whom, such as the prostate specific membrane antigen (PSMA), can also be exploited as therapeutic targets, thus combining diagnosis and therapy in the so-called "theranostic" approach. In this review, we performed a web-based and desktop literature research to investigate the prognostic and theranostic potential of several PET imaging probes, such as F-FDG, F-choline and Ga-PSMA-11, also covering the emerging tracers still in a pre-clinical phase (e.g., PARP-inhibitors' analogs and the radioligands binding to gastrin releasing peptide receptors/GRPR), highlighting their potential for defining personalized care pathways in mCRPC.
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http://dx.doi.org/10.3390/ijms22063036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002334PMC
March 2021

Neuroendocrine Carcinomas with Atypical Proliferation Index and Clinical Behavior: A Systematic Review.

Cancers (Basel) 2021 Mar 12;13(6). Epub 2021 Mar 12.

Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy.

Background: Highly proliferative (G3) neuroendocrine neoplasms are divided into well differentiated tumors (NETs) and poorly differentiated carcinomas (NECs), based on the morphological appearance. This systematic review aims to evaluate the clinicopathological features and the treatment response of the NEC subgroup with a Ki67 labeling index (LI) < 55%.

Methods: A literature search was performed using MEDLINE, Cochrane Library, and Scopus between December 2019 and April 2020, last update in October 2020. We included studies reporting data on the clinicopathological characteristics, survival, and/or therapy efficacy of patients with NECs, in which the Ki67 LI was specified.

Results: 8 papers were included, on a total of 268 NEC affected patients. NECs with a Ki67 LI < 55% have been reported in patients of both sexes, mainly of sixth decade, pancreatic origin, and large-cell morphology. The prevalent treatment choice was chemotherapy, followed by surgery and, in only one study, peptide receptor radionuclide therapy. The subgroup of patients with NEC with a Ki67 LI < 55% showed longer overall survival and progression free survival and higher response rates than the subgroup of patients with a tumor with higher Ki67 LI (≥55%).

Conclusions: NECs are heterogeneous tumors. The subgroup with a Ki67 LI < 55% has a better prognosis and should be treated and monitored differently from NECs with a Ki67 LI ≥ 55%.
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http://dx.doi.org/10.3390/cancers13061247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999788PMC
March 2021

A Rare Case of a Pediatric Patient Affected by Crossed Fused Renal Ectopia: The usefulness of Dual TracerTc-Diethylenetriamine Pentaacetic Acid/Tc-Dimercaptosuccinic Acid Scintigraphy.

Indian J Nucl Med 2020 Oct-Dec;35(4):374-376. Epub 2020 Oct 21.

Department of Maternal and Child Health, UOC of Latina, University of La Sapienza Roma, Roma, Italy.

A 9-year-old male patient, with an ultrasonography diagnosis of horseshoe kidney condition, was referred to our hospital for recurrent urinary tract infection. He was submitted to Tc-diethylenetriamine pentaacetic acid sequential scintigraphy that demonstrated urine stasis in the calyces of both kidneys and was also suggestive for 8-shaped right-to-left crossed-fused renal ectopia. A subsequently performed Tc-dimercaptosuccinic acid scan confirmed the diagnosis of crossed renal ectopia, also disclosing, through single-photon emission computed tomography (SPECT) acquisition, cortical uptake defects in both kidneys, and indicative of renal scarring due to recurrent pyelonephritis. Combined scintigraphy and appropriate technological approaches (SPECT/3D volume rendering) may be useful in selected patients with congenital anomalies.
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http://dx.doi.org/10.4103/ijnm.IJNM_136_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905287PMC
October 2020

Molecular and metabolic imaging of castration-resistant prostate cancer: state of art and future prospects.

Curr Mol Med 2021 Feb 10. Epub 2021 Feb 10.

Nuclear Medicine Department, "Santa Maria Goretti" Hospital, via Canova, 04100, Latina. Italy.

Prostate cancer (PCa) represents the most common tumor in male and one of the most relevant causes of death in Western countries. Androgen deprivation therapy (ADT) constitutes a widely used approach in advanced PCa. When PCa progresses in spite of ADT and castrate levels of testosterone, the severe clinical condition termed as metastatic castration-resistant prostate cancer (mCRPC) takes place. The only approach to mCRPC has been represented by chemotherapy with taxanes for many years. Nevertheless, recently introduced treatments such as 2nd generation antiandrogens (i.e. enzalutamide and abiraterone), cell immunotherapy with sipuleucel-T or targeted alpha therapy with 223Ra-dichloride, have dramatically changed mCRPC prognosis. These novel therapies call for an unmet need for imaging biomarkers suitable for patients' pre-treatment stratification and response assessment. In this scenario, nuclear medicine can provide several metabolic and molecular probes for investigating pathological processes at a cellular and sub-cellular level. The aim of this paper is to review the most relevant findings of the literature published to date on this topic, giving particular emphasis to the pros and cons of each tracer and also covering future prospects for defining personalized therapeutic approaches.
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http://dx.doi.org/10.2174/1566524021666210211112423DOI Listing
February 2021

F-choline PET-aided repeated Y-radioembolization in a patient with large hepatocellular carcinoma and portal vein tumor thrombosis.

Rev Esp Med Nucl Imagen Mol (Engl Ed) 2021 May-Jun;40(3):181-183. Epub 2021 Feb 5.

Unidad de Medicina Nuclear, Hospital Santa María Goretti, Latina, Italia.

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http://dx.doi.org/10.1016/j.remn.2020.03.018DOI Listing
February 2021

International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres.

Eur J Nucl Med Mol Imaging 2021 05 12;48(5):1570-1584. Epub 2021 Jan 12.

Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium.

Purpose: A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (Y)-resin microspheres.

Methods: A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%-79%, no agreement ≤ 49%).

Results: Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and Tc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100-120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement).

Conclusion: Practitioners are encouraged to work towards adoption of these recommendations.
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http://dx.doi.org/10.1007/s00259-020-05163-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113219PMC
May 2021

Metastatic penile squamous cell carcinoma successfully treated with cemiplimab in an HIV patient.

Dermatol Ther 2021 03 17;34(2):e14744. Epub 2021 Jan 17.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy.

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http://dx.doi.org/10.1111/dth.14744DOI Listing
March 2021

Prognostic Value of F-Choline PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Radium-223.

Biomedicines 2020 Nov 30;8(12). Epub 2020 Nov 30.

Department of Nuclear Medicine, "Santa Maria Goretti" Hospital, 04100 Latina, Italy.

We aimed to investigate the role of positron emission computed tomography (PET/CT) with F-choline for predicting the outcome of metastatic castration-resistant prostate cancer (mCRPC) submitted to treatment with Radium-223 (Ra-therapy). Clinical records of 20 mCRPC patients submitted to PET/CT with F-choline before Ra-therapy were retrospectively evaluated. The following PET-derived parameters were calculated: number of lesions, maximum and mean standardized uptake values (SUVmax, SUVmean), lean body mass corrected SUV peak (SULpeak), metabolic tumor volume (MATV), and total lesion activity (TLA). After Ra-therapy, all patients underwent regular follow-up until death. The predictive power of clinical and PET-derived parameters on overall survival (OS) was assessed by Kaplan-Meier analysis and the Cox proportional hazard method. All the patients showed F-choline-avid lesions at baseline PET/CT. Among the enrolled subjects, eleven (55%) completed all the six scheduled cycles of Ra-therapy; seven (35%) were responders according to imaging and biochemical parameters. Mean OS was 12.7 ± 1.4 months: by Kaplan-Meier analysis, number of lesions, PSA level and TLA were significantly correlated with OS. In multivariate Cox analysis, TLA remained the only significant predictor of survival ( = 0.003; hazard ratio = 7.6, 95% confidence interval = 1.9-29.5 months). F-choline PET may be useful for patients' stratification before Ra-therapy. In particular, high metabolically active tumor burden (i.e., TLA) was predictive of poor outcome.
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http://dx.doi.org/10.3390/biomedicines8120555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760591PMC
November 2020

Molecular imaging in immuno-oncology: current status and translational perspectives.

Expert Rev Mol Diagn 2020 12 7;20(12):1199-1211. Epub 2020 Dec 7.

Department of Nuclear Medicine, Santa Maria Goretti Hospital, AUSL , Latina, Italy.

: Only 20-40% of patients respond to therapy with immune checkpoint inhibitors (ICIs). Therefore, the early identification of subjects that can benefit from such therapeutic regimen is mandatory. : The immunobiological mechanisms of ICIs are briefly illustrated. Furthermore, the limitations of traditional radiological approaches are covered. Then, the pros and cons of molecular imaging through positron emission computed tomography (PET/CT) are reviewed, with a particular focus on f-fluorodeoxyglucose (F-FDG) and PET-derived metabolic parameters. Lastly, translational perspective of radiopharmaceuticals others than F-FDG such as zirconium (Zr) or fluorine-18 (F) labeled monoclonal antibodies (e.g.Zr-atezolizumab, Zr-nivolumab) binding to specific biomarkers are discussed. : Molecular imaging presents a prominent role for the management of oncological patients treated with ICIs. Preliminary clinical data indicate that PET/CT with F-FDG is useful for assessing the response to treatment and for the imaging of immune-related adverse effects. Nevertheless, the methodological approach (iPERCIST, PERCIMT, or others) to be used for an optimal diagnostic accuracy and patients' evaluation is still a debated issue. PET/CT with radioligands directed toward ICIs biomarkers, although is still in a translational phase, holds the promise of accurately predicting the response to treatment and revealing the acquired resistance to immunotherapy.
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http://dx.doi.org/10.1080/14737159.2020.1854090DOI Listing
December 2020

Acute Promyelocytic Leukemia After Radium-223 Exposure for Prostate Cancer in a Chemotherapy-Naïve Patient.

Nucl Med Mol Imaging 2020 Oct 9;54(5):256-260. Epub 2020 Jul 9.

Hematology, Polo Universitario Pontino, "Sapienza", Via A. Canova S.M. Goretti Hospital, Latina, Italy.

Ra-dichloride is a bone-seeking targeted alpha (α)-emitting approved for bone metastases in prostate cancer. Here, we report a case of therapy-related acute promyelocytic leukemia (t-APL) following administration of Ra, showing some evidence of a causative relationship. A patient with metastatic prostate cancer received therapy with Ra, with 6 injections of the radiopharmaceutical at a standard dose of 55 kBq/kg at 4-week intervals for a cumulative administered activity of 26.3 MBq. PET/CT with F-methylcholine repeated 1 month after the conclusion of Ra was negative. After 8 months, he developed pancytopenia and we made a diagnosis of therapy-related acute promyelocytic leukemia (t-APL). We then studied the genomic locations of the breakpoints in the PML and RARA genes, which were at nucleotide positions 1708-09 of PML intron 3, respectively, outside the previously reported Topo II-associated hotspot region. t-APL was cured with all-trans-retinoic acid (ATRA) and arsenic trioxide. The type of PML/RARA rearrangement we identified, in absence of other myelotoxic treatments, is suggestive of a possible direct causal relationship with exposure to Ra and warrants further investigations.
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http://dx.doi.org/10.1007/s13139-020-00652-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560650PMC
October 2020

Atrial Metastasis From Sarcomatoid Renal Cell Carcinoma: Integration Between 18F-FDG PET/CT and Cardiac 3-Dimensional Volume Rendering.

Clin Nucl Med 2020 Dec;45(12):970-972

From the Nuclear Medicine Unit.

We describe the case of a 54-year-old woman, previously submitted to nephrectomy for sarcomatoid renal cell carcinoma and treated with antibiotics because of central venous catheter infection. An F-FDG PET/CT scan was obtained that demonstrated bone and lymph node metastases and also disclosed an irregular area of highly increased uptake (SUVmax 19.4) in the right atrium. Clinical data did not suggest a relapsed infection. A contrast-enhanced CT examination of the heart enabled the diagnosis of intra-atrial metastasis. Furthermore, integration between PET and cardiac 3-dimensional volume rendering proved useful for defining the anatomical relationships between atrial metastasis and large vessels.
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http://dx.doi.org/10.1097/RLU.0000000000003302DOI Listing
December 2020

The potential of PSMA-targeted alpha therapy in the management of prostate cancer.

Expert Rev Anticancer Ther 2020 10 3;20(10):823-829. Epub 2020 Sep 3.

Department of Nuclear Medicine, Santa Maria Goretti Hospital , Latina, Italy.

Introduction: Alpha emitters present several advantages for cancer therapy. The radiopharmaceutical Ra-dichloride has been recently introduced for the targeted alpha therapy (TAT) of metastastic castration-resistant prostate cancer (mCRPC). However, since Ra-dichloride targets only skeletal lesions, its use in clinical practice is recommended only in subjects without visceral metastases. To overcome this, several efforts have been made to develop radiopharmaceuticals suitable for TAT and specifically directed toward the biomarker prostate specific membrane antigen (PSMA), overexpressed by both skeletal and visceral metastases from mCRPC.

Areas Covered: The radiobiological principles concerning TAT applications are covered, with particular emphasis on its pros and cons, especially in comparison with beta-emitter radionuclide therapy. Furthermore, the role of PSMA as a theranostic target for imaging and therapy is reviewed. Lastly, the pre-clinical and clinical applications of TAT through 225Actinium (AC) and 213Bismuth (Bi) are discussed.

Expert Opinion: PSMA-based TAT holds the promise of becoming a powerful tool for the management of mCRPC. Nevertheless, several issues have still to be addressed, especially concerning TAT toxicity. Furthermore, several efforts have to be made for identifying the more adequate alpha-emitter (Ac vs Bi) with a view to the patient's tailored therapeutic approach.
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http://dx.doi.org/10.1080/14737140.2020.1814151DOI Listing
October 2020

Role of 18F-FDG PET-derived parameters for predicting complete response to chemoradiotherapy in squamous cell anal carcinoma.

Nucl Med Commun 2020 Oct;41(10):1089-1094

Nuclear Medicine Unit, 'Santa Maria Goretti' Latina.

Purpose: We aimed to evaluate the accuracy of metabolic parameters, calculated on pretreatment positron emission computed tomography (PET/CT) with fluorodeoxyglucose (F-FDG), for predicting complete response to chemoradiotherapy (CRT) of patients affected by squamous cell anal carcinoma (SCAC).

Patients And Methods: Clinical records of 20 patients affected by SCAC and treated with CRT were retrospectively evaluated. F-FDG PET/CT was performed at time 0 (baseline) and time 1 (12 weeks after CRT). The following parameters were extracted from PET at time 0: standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Response was assessed according to PET response criteria in solid tumors and classified as complete metabolic response (CMR), partial metabolic response (PMR) and progressive metabolic disease (PMD). Receiver operating characteristic analysis was performed to analyze the predictive value of each PET-derived parameter on CMR.

Results: Sixteen patients were finally enrolled. All presented increased F-FDG uptake in the primary tumor and 11 (68.7%) also showed metastatic lymph nodes. At PET/CT performed at time 1, 11 subjects (68.7%) presented CMR, three (18.7%) had PMR and the remaining two (12.5%) showed PMD (i.e. hepatic metastases). Among baseline PET-derived parameters, both MTV and TLG efficiently predicted response to CRT with an area under the curve of 0.9 (cutoff 62.3 cm, sensitivity 80%, specificity 100%, P = <0.0001) and 0.87 (cutoff 654.1 g, sensitivity 80%, specificity 100%, P = 0.004), respectively.

Conclusion: Among PET-derived parameters, both MTV and TLG presented a high predictive value on subjects' outcome after CRT.
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http://dx.doi.org/10.1097/MNM.0000000000001260DOI Listing
October 2020

Aptamer-based technology for radionuclide targeted imaging and therapy: a promising weapon against cancer.

Expert Rev Med Devices 2020 Aug 27;17(8):751-758. Epub 2020 Jul 27.

Department of Medical and Surgical Sciences and Biotechnology, University of Rome "La Sapienza" , Latina, Italy.

Introduction: aptamers are short artificial, single-strand oligonucleotide sequences (DNA, RNA or modified RNA), capable of binding to biological molecules with high affinity and specificity. Due to their relatively low cost of production and scarce immunogenicity, many efforts have been made to produce aptamers directed against specific molecular targets, such as receptors or transporters overexpressed by malignancies.

Areas Covered: the technological approaches for generating aptamers are reviewed. Furthermore, the applications of radiolabeled aptamers for the imaging of several oncological biomarkers through single photon emission computed tomography (SPECT) or positron emission tomography (PET), are covered. Lastly, targeted therapy based on the utilization of aptamers labeled with radionuclides emitting beta particles is discussed, with particular emphasis to the oncological perspectives.

Expert Opinion: The main limitation of radiolabeled aptamers is represented by their sensitivity to endogenous nuclease, so that several strategies have been developed to increase the stability of these compounds. Although the applications of aptamers are still in a preliminary and pre-clinical phase, it is reasonable to hypothesize that this technology will play a major role for personalized medicine in the next years.
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http://dx.doi.org/10.1080/17434440.2020.1796633DOI Listing
August 2020

Re: "Sgc8-c Aptamer as a Potential Theranostic Agent for Hemato-Oncological Malignancies" by Sicco et al.

Cancer Biother Radiopharm 2020 10 9;35(8):626. Epub 2020 Jul 9.

Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.

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http://dx.doi.org/10.1089/cbr.2020.4014DOI Listing
October 2020

Molecular and Metabolic Imaging of Hepatic Neuroendocrine Tumors Following Radioembolization with 90Y-microspheres.

Curr Med Imaging 2020 ;16(5):545-552

Department of Nuclear Medicine, Santa Maria Goretti Hospital, Via Canova 3, Latina 04100, Italy.

Liver is the predominant site of metastatization for neuroendocrine tumors (NETs). Up to 75% of patients affected by intestinal NETs present liver metastases at diagnosis. For hepatic NET, surgery represents the most effective approach but is often unfeasible due to the massive involvement of multifocal disease. In such cases, chemotherapy, peptide receptor radionuclide therapy and loco-regional treatments may represent alternative therapeutic options. In particular, radioembolization with 90Y-microspheres has been introduced as a novel technique for treating hepatic malignant lesions, combining the principles of embolization and radiation therapy. In order to evaluate the response to 90Y-radioembolization, standard radiologic criteria have been demonstrated to present several limitations. 18Fluoro-deoxyglucose (FDG) Positron Emission Tomography (PET) is routinely used for monitoring the response to therapy in oncology. Nevertheless, NETs often present low glycolytic activity thus the conventional 18FDG PET may not be adequate for these tumors. For many years, somatostatin receptor scintigraphy (SRS) with 111In-pentetreotide has been used for diagnosis and staging of NETs. More recently, three 68Ga-DOTA-compounds have been developed and introduced for the imaging of NETs with PET technology. The aim of the present paper was to review the existing literature concerning the application of different metabolic and molecular probes for the imaging evaluation of hepatic NETs following 90Y-RE.
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http://dx.doi.org/10.2174/1573405615666190114150038DOI Listing
June 2021

Theranostic approaches in nuclear medicine: current status and future prospects.

Expert Rev Med Devices 2020 Apr 19;17(4):331-343. Epub 2020 Mar 19.

Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy.

: Theranostics is an emerging field in which diagnosis and specific targeted therapy are combined to achieve a personalized treatment approach to the patient. In nuclear medicine clinical practice, theranostics is often performed utilizing the same molecule labeled with two different radionuclides, one radionuclide for imaging and another for therapy.: The authors review the clinical applications of different radiopharmaceuticals in the field of interest, including the well-established use of radioactive iodine in differentiated thyroid cancer, radiolabeled metaiodobenzylguanidine (MIBG) in neuroblastoma and the clinical impact of peptide radionuclide receptorial therapy (PRRT) in the management of neuroendocrine tumors. Furthermore, the more cutting-edge and recently introduced theranostic approaches will be reviewed, such as the radioligand therapy with Lu-prostate specific membrane antigen (PSMA) and targeted alpha therapy in castration-resistant prostate cancer. Finally, the main applications of PET for the imaging of biomarkers suitable for the non-radionuclide targeted therapy will be covered.: Theranostics is envisaging a revolutionary clinical approach which is deeply connected with the concept of personalized medicine and ruled by a 'patient-centered' vision. In this perspective, the theranostic applications will need well-trained specialists, capable to manage not only the technological aspects of the discipline, but also to deal with the more innovative oncological therapies in a multidisciplinary setting.
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http://dx.doi.org/10.1080/17434440.2020.1741348DOI Listing
April 2020

The Relationship Between Total Lesion Activity on F Choline Positron Emission Tomography-Computed Tomography and Clinical Outcome in Patients with Castration-Resistant Prostate Cancer Bone Metastases Treated with Radium.

Cancer Biother Radiopharm 2020 Aug 28;35(6):398-403. Epub 2020 Feb 28.

Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy.

The aim of the study was to assess the correlation between metabolic response measured through positron emission tomography-computed tomography (PET-CT) with F choline (F FCH) and overall survival (OS) in patients affected by bone lesions from metastatic castration-resistant prostate cancer treated with Ra dichloride. Eleven subjects were subjected to PET-CT with F FCH before and 1 month after Ra treatment. Reduction in total lesion activity (ΔTLA) between pretreatment and post-treatment scan was determined and patients were divided into responders (ΔTLA >50%) and nonresponders (ΔTLA <50%). The OS of the entire cohort was 12.7 ± 3.8 months. Kaplan-Meier analysis showed that responders presented a significantly longer survival than nonresponders (16.5 ± 1.9 months vs. 10.5 ± 0.9 months,  < 0.05). Reduction in TLA after Ra treatment seems to be correlated with a trend toward a longer survival.
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http://dx.doi.org/10.1089/cbr.2019.3188DOI Listing
August 2020

Prognostic value of neutrophil-to-lymphocyte ratio and its correlation with fluorine-18-fluorodeoxyglucose metabolic parameters in intrahepatic cholangiocarcinoma submitted to 90Y-radioembolization.

Nucl Med Commun 2020 Jan;41(1):78-86

Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina.

Objective: The aim of this study was to investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and its relationship with several metabolic parameters obtained through PET in intrahepatic cholangiocarcinoma (ICC) submitted to radioembolization with Y-microspheres (Y-radioembolization).

Methods: Records of 20 subjects affected by ICC and submitted to Y-radioembolization were retrospectively evaluated. In all cases, pretreatment NLR was carried out and fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT was acquired with the calculation of the following metabolic parameters: maximum and mean standardized uptake value (SUVmax and SUVmean), metabolic total volume and total lesion glycolysis. After Y-radioembolization, all patients underwent regular imaging and laboratory follow-up.

Results: All patients presented F-FDG-avid hepatic tumors at pretreatment PET/CT examination. NLR significantly correlated with SUVmax (r = 0.64; P = 0.002) and SUVmean (r = 0.67; P = 0.001). After treatment with Y-microspheres, the mean OS resulted 12.5 ± 1.5 months. When the average pretreatment NLR value (i.e. 2.7) was used as a cutoff for patients' stratification, subjects with low NLR (<2.7) had a significantly longer OS than those with high NLR (>2.7). At Cox regression analysis including bilirubin, age, the presence of extrahepatic disease, hepatitis C virus/hepatitis B virus status and PET-derived parameters, only NLR resulted to be a significant predictor of OS (P = 0.01; hazard ratio = 13.1, 95% confidence interval = 1.6-102.7).

Conclusion: NLR is correlated with SUVmax-mean values in ICC and resulted to be an easy available predictor of survival in patients submitted to treatment with Y-microspheres.
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http://dx.doi.org/10.1097/MNM.0000000000001123DOI Listing
January 2020

Mycobacterial Lymphadenitis in a Human Immunodeficiency Virus-Infected Patient: Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography for Diagnosis and Monitoring the Response to Treatment.

Indian J Nucl Med 2019 Oct-Dec;34(4):329-331

Nuclear Medicine Unit, "Santa Maria Goretti" Hospital, Latina, Italy.

Lymphadenitis, due to typical or atypical , is a clinical condition frequently associated with human immunodeficiency virus (HIV) infection. Differential diagnosis between benign and malignant causes may be a challenge for clinicians. In this regard, the role of positron emission tomography (PET) with F-fluorodeoxyglucose (F-FDG) has still not been fully explored. We describe a case of 30-year-old male, infected by HIV, with mycobacterial lymphadenitis, in which FDG-PET and PET-derived parameters resulted useful for guiding diagnosis and monitoring the response to treatment.
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http://dx.doi.org/10.4103/ijnm.IJNM_125_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771195PMC
October 2019

Re: Hepatocellular Carcinoma Mimicking Neuroendocrine Tumor Metastasis on 68Ga-DOTATATE PET/CT.

Clin Nucl Med 2020 03;45(3):258-259

Nuclear Medicine Unit "Santa Maria Goretti" Hospital Latina, Italy

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http://dx.doi.org/10.1097/RLU.0000000000002634DOI Listing
March 2020

Recent advances in PET probes for hepatocellular carcinoma characterization.

Expert Rev Med Devices 2019 05 28;16(5):341-350. Epub 2019 Apr 28.

a Department of Nuclear Medicine , Santa Maria Goretti Hospital , Latina , Italy.

Introduction: Positron Emission Tomography (PET) with F-fluorodeoxyglucose (FDG) presents some limitations for imaging of hepatocellular carcinoma (HCC), the most common primary hepatic malignancy.

Areas Covered: The authors discuss the accuracy and limitations of FDG for HCC detection. Then, authors examine the recent advances in PET tracers other than FDG for the biological and prognostic characterization of HCC such as C-acetate, C-choline, and its F-labeled derivatives.

Expert Commentary: FDG PET can be helpful for the identification of the more aggressive and poorly differentiated HCC. C-acetate is readily incorporated into intracellular phosphatidylcholine membranes and proved useful for the in vivo biological characterization of the more differentiated and less aggressive HCC. Nevertheless, the short half-life of C- radionuclide limits the clinical application of this compound. C-choline, another surrogate biomarker of cell membrane biosynthesis, has been demonstrated effective for HCC imaging. The availability of choline derivatives labeled with F-radionuclide (i.e. F-fluoroethylcholine, F-fluorocholine) has overcome the drawbacks due to C, thus triggering the clinical applications of choline PET for HCC diagnosis and management. Further research needs to be conducted to better define the alternative or complementary role of these PET probes for the characterization of HCC, with particular regard to the dual-tracer PET-CT modality.
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http://dx.doi.org/10.1080/17434440.2019.1608817DOI Listing
May 2019

Imaging Neuroendocrine Hepatic Metastases Following Y-Radioembolization: Is It Time to Implement Routine Use of PET Molecular/Metabolic Probes?

Cardiovasc Intervent Radiol 2019 06 19;42(6):933-934. Epub 2019 Feb 19.

Nuclear Medicine Unit, "Santa Maria Goretti" Hospital, via Canova, Latina, Italy.

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http://dx.doi.org/10.1007/s00270-019-02186-wDOI Listing
June 2019

Repeated Treatment with Y-Microspheres in Intrahepatic Cholangiocarcinoma Relapsed After the First Radioembolization.

Cancer Biother Radiopharm 2019 May 13;34(4):231-237. Epub 2019 Feb 13.

1 Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy.

The aim of this study was to evaluate the safety and efficacy of repeated administration of Y-microspheres in intrahepatic cholangiocarcinoma (ICC) relapsed after the first radioembolization (RE). Nine patients with ICC relapsed after the first Y-RE were enrolled. Six patients presented recurrence in the right hepatic lobe, 3 in the left lobe. All subjects underwent a second administration of Y-resin microspheres. Toxicity was assessed according to Common Terminology Criteria for Adverse Events (CTCAE, version 4.02). After the repeated treatment, all patients were submitted to follow-up with laboratory, imaging, and clinical examinations. The mean cumulative activity administered considering both treatments was 2.7 ± 0.5 GBq. After the second treatment, 3 patients presented complete metabolic response (33.3%) and 6 had partial response (66.6%). The following adverse events were registered: transient increased levels of liver enzymes (grade 1 = 4; grade 2 = 2), hyperbilirubinemia (grade 1 = 2), ascites (grade 2 = 1), and duodenal ulcer (grade 2 = 1). Two patients developed a significant shrinking of the targeted hepatic lobe, as for radiation lobectomy. No case of RE-induced liver disease was registered. Median overall survival was 16.5 ± 1.4 months after the first RE. The authors' results suggest that repeated administration of Y-microspheres may be considered in patients affected by ICC relapsed after the first Y-RE.
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http://dx.doi.org/10.1089/cbr.2018.2718DOI Listing
May 2019

Comparison of F FDG PET-CT AND CECT in pretreatment staging of adults with Hodgkin's lymphoma.

Leuk Res 2019 01 5;76:48-52. Epub 2018 Dec 5.

Hematology, Department of Translation and Precision Medicine, "Sapienza" University of Rome, Italy; Hematology Unit, S. Maria Goretti Hospital, AUSL Latina, Italy. Electronic address:

We compared 2-[fluorine-18] fluoro-2-deoxy-d-glucose PET-CT and contrast-enhanced computed tomography (CECT) in 62 consecutive patients with newly diagnosed Hodgkin Lymphoma (HL), aiming to provide evidences that may spare CECT from the staging procedures of HL patients. Among a total of 1448 nodal sites examined, disease involvement was detected in 232 (16%) and 280 (19.3%) nodal areas by CECT and PET-CT, respectively (P < 0.01). Sensitivity of CECT in detecting disease involvement ranged from 0% for internal mammary region (7 cases) and Waldayer's ring (1 case) to 100% for mediastinum. A total of 248 extranodal areas were examined. CECT and PET-CT identified disease involvement in 19 (7.7%) and 25 (10.1%) extranodal areas, respectively (P = n.s). Compared to PET-CT, CECT detected a lower number of cases with bone and/or bone marrow involvement (P = 0.05), whereas no differences were detected at the level of lung. By contrast, CECT identified liver lesions in four patients versus three identified by PET-CT. In comparison to CECT, PET-CT upstaged 6 patients (9.7%) and downstaged 1 patient (1.6%). We showed that PET-CT modified treatment strategy in five (8.1%) cases not only as a result of stage advancement (2 cases) but also of a different prognostic stratification in patients with localized disease (3 cases), due to the better sensitivity in detecting nodal involvement. In conclusion, our data, confirm the superiority of PET-CT in detecting disease involvement at diagnosis of HL, and further supports the possibility to replace CECT with PET-CT in the initial staging of HL.
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http://dx.doi.org/10.1016/j.leukres.2018.11.018DOI Listing
January 2019
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