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Indian Journal of Cancer, Vol. 47, No. 2, April-June, 2010, pp. 98-99 Symposium-Editorial From pure research imaging tool to PET-guided personalized medicine in oncology: A true revolution in modern medicine Basu S Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Parel, Mumbai, India Correspondence Address: Dr. Sandip Basu, Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Parel, Mumbai, India drsanb@yahoo.com Code Number: cn10031 PMID: 20448370 DOI: 10.4103/0019-509X.62994 The impact of molecular imaging with PET(Positron Emission Tomography) and PET-CT (PET-Computed Tomography) in the practice of oncology has been truly revolutionary. This powerful imaging technology has become the cornerstone in the management of a wide array of malignancies, where it has become essential in disease staging, monitoring response to treatment, planning and choosing appropriate therapies, detecting recurrence, characterizing tumor biology and thereby predicting prognosis. [1],[2] The detailed structural and functional imaging information provided by PET-CT has significantly improved lesion delineation and characterization both at the primary and the metastatic sites and is now regarded by many as the ′one-stop-shop′ for several malignancies. In this treatise, the authors have made an attempt to have a critical look at the impact of PET and PET-CT imaging in the practice of oncology from all the aforementioned aspects. This is a topic which many of us are passionate about and it is sincerely hoped that these scholarly reviews written by a stellar group of authors, which the editor is delighted to present to the readers, will provide comprehensive and useful sources of reference in the next few years. The fluorodeoxyglucose (FDG) technique was introduced in 1976 by the investigators at the University of Pennsylvania, and was initially proposed as a novel tracer to determine regional brain function in normal physiologic states and in neuropsychiatric disorders. Subsequently, the critical role of PET imaging with FDG and with other novel tracers as molecular probes has been demonstrated in the investigation of a number of malignancies. One of the highlights of this minisymposium is to have Professor Abass Alavi of the Hospital of University of Pennsylvania as a co-author to two reviews. He is an internationally renowned expert in the modern imaging sciences, especially in the clinical applications of PET imaging for the detection of cancer as well as neurological, cardiovascular, and infectious disorders. Dr Alavi was very instrumental in introducing FDG into the practice of medicine. In fact, he was the first scientist to administer FDG to two normal human volunteers in August, 1976, at the University of Pennsylvania. Brain and whole body images were obtained with an ordinary (non-PET) nuclear scanner which demonstrated the concentration of FDG in the brain and other organ of body. We are now in the era of evidence-based medicine where it is important to have a critical look at the impact of FDG-PET and PET-CT on each of the malignancies, based upon the published literature. The first review by Kumar and colleagues [3] has been dedicated to this end. As the new literature on PET-CT imaging is emerging, such academic exercise, from time to time, is pivotal to enhance the knowledge of the practicing oncologists and to define the precise role of this modality in each setting. While the clinical PET imaging over the last two decades has been dominated by FDG across the world, new PET tracers are on the horizon that can provide information on various aspects of metabolism in a variety of tumors and it is likely that the trend in the practice of PET will undergo significant changes in the next several years because of the anticipated increase in use of these novel PET agents. Dr Caroli and colleagues [4] from the University of Bologna, Italy, have been one of the most active groups in this area and have built up their review on this very important topic that has been relatively less explored at this point but is evolving rapidly in the recent years. As the authors mention, FDG-PET shows significant shortcoming in certain malignancies like prostate cancer, liver cancer, central nervous system (CNS) tumors and neuroendocrine tumors (NET). The introduction of Gallium-68 labeled radiopharmaceuticals as viable PET agents has added a new dimension to the management of patients with NET by providing high quality images compared with planar or Single photon emission computed tomography (SPECT) with single photon emitting preparations. The development of 68 Ga-DOTA labeled somatostatin analogues has been the key to this success and this has further stimulated research into the development of DOTA-derivative peptides and led to the evolution of generator-based 68 Ga-PET radio pharmacy. 18 F-labeled DOPA has demonstrated similar promise in this group of tumors. Similarly, Choline labeled with either 11 C or 18 F, which has a high affinity for malignant prostate tissue, has been a significant advance in prostate cancer imaging. The current experience with such agents is relatively limited and therefore prospective studies are required to further define their precise role in different tumors. The practice of Nuclear Medicine as well as Clinical Oncology in the pediatric population has been dealt with on a different note, especially over the last two decades, in order to address the diseases and issues that are specific to this age group. Similar concerns, though exist in the day-to-day practice of PET-CT imaging, are relatively unexplored. In Part 2 of this mini symposium, the readers will have an opportunity to read about a holistic approach towards the application of FDG-PET and PET-CT in pediatric oncology with the help of Dr Samuel who has elegantly portrayed important aspects. Though there may been some overlapping topics between her article and the first review by Kumar et al. they will provide the reader with a broader perspective. Utilizing the invaluable functional information of PET for radiotherapy planning has greatly interested the radiation oncologists and the nuclear medicine fraternity alike. The introduction of hybrid imaging with PET-CT has provided significant impetus and revolutionized to PET based RT planning. Gupta and Beriwal, [5] in their scholarly review, overview the current status and advantages of radiation treatment planning based on tumor biology rather than solely upon tumor morphology. The future potential of the combined structure-function approach in this area is limitless and a fruitful collaboration between the radiation oncologists and the nuclear medicine physician is crucial for the success of this promising application. Individualizing treatment in cancer patients is an evolving concept at present, which many of us believe will rely heavily on the success of metabolic imaging with current and the future novel PET tracers and prove to be significantly superior to the existing structural imaging techniques. It is perceivable that in the near future, the introduction of a large number of organ-specific and disease-specific PET tracers coupled with development of sophisticated techniques like incorporation of MRI into hybrid devices will substantially enhance the role of combined structure-function approach in the management of cancer and other serious disorders. The introduction of PET and subsequently the development of hybrid imaging has been probably the single most innovation in recent times in the field of oncological imaging. Hence, it was a privilege for the editor to put together a mini-symposium on this very important topic for the Indian Journal of Cancer. This provided the authors and indeed, the guest editor, with the opportunity to address, in considerable depth, the many facets of the PET imaging in the practice of oncology. I hope that the readers will find these remarkable reviews highly informative as much as I have. References
Copyright 2010 - Indian Journal of Cancer |
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