Nuclear oncology GIÁO TRÌNH UNG THƯ học hạt NHÂN

Gad Abikhzer, MDCM, NM Fellow Department of Nuclear Medicine Rambam Health Care Campus Palo Alto, California Abass Alavi, MD, MD Hon, PhD Hon, DSc Hon Department of Nuclear Medicine Fond

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NUCLEAR ONCOLOGY

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Cumali Aktolun, MD, MSc

Visiting ProfessorDepartment of RadiologyMolecular Imaging Program at Stanford, School of Medicine

Stanford UniversityPalo Alto, CaliforniaStanley J Goldsmith, MD

ProfessorDepartment of Radiology and MedicineSanford and Joan Weill College of Medicine of Cornell University

Director-EmeritusDivision of Nuclear Medicine and Molecular ImagingNew York-Presbyterian Hospital / Weill Cornell Medical Center

New York, New York

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Nuclear oncology (Aktolun)

Nuclear oncology / [edited by] Cumali Aktolun, Stanley J Goldsmith.

p ; cm.

Includes bibliographical references and index.

ISBN 978-1-4511-8685-7 (alk paper) – ISBN 1-4511-8685-1 (alk paper)

I Aktolun, C (Cumali), 1961- editor II Goldsmith, Stanley J., editor III Title.

[DNLM: 1 Neoplasms–radionuclide imaging 2 Neoplasms–radiotherapy 3 Radionuclide Imaging–methods 4.

Radiotherapy–methods. QZ 241]

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2014009474 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient The publisher does not provide medical advice or guidance and this work is merely a reference tool Healthcare professionals, and not the publisher, are solely responsible for the use

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Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contradictions, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

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To my wife, Miriam Goldsmith, who dedicated her life to our family, to myprofessional goals, and to me Her love made possible the life that I have been

fortunate enough to have lived

Stanley J Goldsmith, MD

To Mustafa Kemal Ataturk, the founder of Republic of Turkey, who established

the foundations of modern scientific education in my country

Cumali Aktolun, MD, MSc

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Gad Abikhzer, MDCM, NM

Fellow

Department of Nuclear Medicine

Rambam Health Care Campus

Palo Alto, California

Abass Alavi, MD, MD (Hon), PhD (Hon), DSc (Hon)

Fondazione IRCCS, Istituto Nazionale dei Tumori

Milan, Italy

Filippo Alongi, MD

Senior Radiation Oncologist

Department of Radiotherapy and Radiosurgery

Istituto di Ricovero e Cura a Carattere Scientifico HumanitasMilan, Italy

Lujaien Al-Rubaiey Kadhim, MSc

Research Consultant

Tawam Molecular Imaging Centre

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Al Ain, United Arab Emirates

Nuclear Medicine Physician

Stefano Arcangeli, MD

Radiation Oncologist

Anna Maria Ascolese, MD

Department of Nuclear Medicine, PET/CT Center

Medikol Outpatient Clinic

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Jelle O Barentsz, MD, PhD

Professor

Department of Radiology

Chairman

Prostate MR Center of Excellence

Radboud University Nijmegen Medical Centre

Nijmegen, The Netherlands

Sandip Basu, MBBS (Hon), DRM, DNB, MNAMG

Head

Nuclear Medicine Academic Program

Radiation Medicine Centre (Bhabha Atomic Research Centre)

Tata Memorial Centre

Nuclear Medicine Department

Ospedale San Raffaele

Milan, Italy

Sibaprasad Bhattacharyya, PhD

Senior Scientist and Head

Imaging Probe Development

Applied and Developmental Research Directorate, Science Applications InternationalCorporation (SAIC)–Frederick

Frederick National Laboratory for Cancer Research

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European Institute of Oncology

Milan, Italy

Andreas K Buck, MD

Professor and Chair

University of Würzburg

Würzburg, Germany

Maria Rita Castellani, MD

Permanent Staff

Milan, Italy

Paolo Castellucci, MD

Consultant

Azienda Ospedaliero-Universitaria di Bologna: Policlinico S Orsola-Malpighi

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Azienda Ospedaliero Universitaria di Bologna: Policlinico S Orsola-Malpighi

Division of Nuclear Medicine

Department of Diagnostic Imaging

Hospital for Sick Children

Toronto, Ontario, Canada

Jean-Francois Chatal, MD, PhD

Emeritus Professor

Groupement d’Intérêt Public Arronax

Nantes, Saint-Herblain, France

Muhammad Ali Chaudhry, MD

Clinical Assistant Professor

Radiology Division

Johns Hopkins University School of Medicine

Baltimore, Maryland

Medical Director

Tawam Molecular Imaging Centre

Al Ain, United Arab Emirates

Xiaoyuan Chen, PhD

Senior Investigator

Laboratory of Molecular Imaging and Nanomedicine

National Institute of Biomedical Imaging and Bioengineering, National Institutes ofHealth

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Philadelphia, Pennsylvania

Arturo Chiti, MD, FEBNM

Director

Humanitas Research Hospital

Clinical PET Centre

Guy’s and St Thomas’ NHS Foundation Trust

London, England, United Kingdom

Flavio Crippa, MD

Permanent Staff, Department of Nuclear Medicine

Milan, Italy

Johannes Czernin, MD

Professor

Department of Molecular and Medical Pharmacology

Chief, Ahmanson Translational Imaging Division

David Geffen School of Medicine at UCLA

University of California Los Angeles, California

Los Angeles, California

Maria Luisa De Rimini, MD

Director of Nuclear Cardiology

AORN–Ospedali dei Colli

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Rochester, Minnesota

Willem M Deserno, MD, MSc, PhD

Radiologist

Laurentius Ziekenhuis

Roermond, The Netherlands

Linda de Wit–van der Veen, MSc, PhD

Antoni van Leeuwenhoek Hospital

Honorary Senior Clinical Lecturer

Brighton and Sussex Medical School

Lead Consultant

Department of Imaging and Nuclear Medicine

Royal Sussex County Hospital

Brighton, England, United Kingdom

Mark Dunphy, DO

Assistant Professor

Weill Cornell Medical College

Assistant Attending Physician

Molecular Imaging and Therapy Service

Memorial Hospital

New York, New York

Matthias P.A Ebert, MD

Chairman and Head

Department of Internal Medicine II

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Ambulatory Care Unit, Department of Oncology

Haifa, Israel

Paola A Erba, MD

Assistant Professor

Regional Center of Nuclear Medicine

Department of Translational Research and Advanced Technology in Medicine andsurgery

University of Pisa

Staff Physician

Department of Radiology, Interventional Radiology, and Nuclear Medicine

University Hospital of Pisa

Pisa, Italy

Thomas Eugène, MD

Physician

Nantes University Hospital

Nantes, France

Stefano Fanti, MD

Chief

Bologna, Italy

Ansje S Fortuin, MD

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Diagnostic Imaging Program, Molecular Imaging Center

National Institute of Radiological Sciences

Chiba, Japan

Stanley J Goldsmith, MD

Professor

Department of Radiology and Medicine

Weill Medical College of Cornell University

Director Emeritus

Division of Nuclear Medicine and Molecular Imaging

New York-Presbyterian Hospital/Weill Cornell Medical CenterNew York, New York

Jun Hatazawa, MD, PhD

Professor

Department of Nuclear Medicine and Tracer Kinetics

Osaka University Graduate School of Medicine

Chief

University of Osaka Hospital

Osaka, Japan

Roland Haubner, PhD

Senior Scientist

Innsbruck Medical University

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Department of Surgery

Uppsala University Hospital

Uppsala, Sweden

Ken Herrmann, MD

Visiting Assistant Professor

Department of Molecular and Medical Pharmacology, Ahmanson Translational ImagingDivision

David Geffen School of Medicine

University of California Los Angeles

Los Angeles, California

Department for Nuclear Medicine

University Medical Centre

Ljubljana, Slovenia

Kayako Isohashi, MD, PhD

Assistant Professor

Osaka, Japan

Revathy B Iyer, MD

Professor

Department of Diagnostic Radiology

The University of Texas MD Anderson Cancer Center

Houston, Texas

Zhao-Hui Jin, MD, PhD

Senior Researcher

Diagnostic Imaging Program, Molecular Imaging Center

National Institute of Radiological Sciences

Chiba, Japan

Zohar Keidar, MD, PhD

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Clinical Assistant Professor

Faculty of Medicine

Technion–Israel Institute of Technology

Deputy Director

New Haven, Connecticut

Kemal Metin Kir, MD

Professor

Ankara University School of Medicine

Cebeci Research and Practice Hospital

Ankara, Turkey

Francoise Kraeber-Bodéré, MD, PhD

Professor

Nantes University Hospital

Nantes, France

ICO René Gauducheau Cancer Center

Saint-Herblain, France

Thomas C Kwee, MD, PhD

Resident

University Medical Center Utrecht

Utrecht, The Netherlands

Marie Lacombe, MD

Nuclear Medicine Department, Integrated Center for OncologyICO René Gauducheau Cancer Center

Saint-Herblain, France

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Cinzia Landolfi, MD

Fellow

AORN - Ospedali dei Colli

Department of Internal Medicine

St Boniface General Hospital

Winnipeg, Manitoba, Canada

Scarlett Lewitschnig, Dr Med Univ., FRACP

St Thomas’ Hospitals NHS Foundation Trust

Francesca Lobefalo, MSc

Medical Physics

University of Milan

Medical Physicist

Egesta Lopci, MD

Alice Lorenzoni, MD

Physician

Milan, Italy

Roberto Luksch, MD

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Distinguished Professor and Chair

Houston, Texas

Chiara Manfredi, PhD

Fellow

Department of Translational Research and Advanced Technology in Medicine andSurgery

Department of Radiology, Interventional Radiology, and Nuclear Medicine

University Hospital of Pisa

Pisa, Italy

Irvin M Modlin, MD, PhD, DSc, FRCS (Eng & Ed)

Professor

Department of Gastroenterological Surgery

Yale University School of Medicine

New Haven, Connecticut

Pietro Muto, MD

Director

AORN–Ospedali dei Colli

Chief

Monaldi Hospital

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Hempstead, New York

Senior Medical Physicist

Nuclear Medicine and Molecular Imaging

North Shore–LIJ Health System

New Hyde Park, New York

Sridhar Nimmagadda, PhD

Assistant Professor

Departments of Radiology, Oncology, and Medicine

Johns Hopkins University School of Medicine

Baltimore, Maryland

Gang Niu, MD, MS

Staff Scientist

Laboratory of Molecular Imaging and Nanomedicine

National Institute of Biomedical Imaging and Bioengineering, National Institutes ofHealth

Centre for Diagnostic Nuclear Imaging

University Putra Malaysia

Serdang, Malaysia

Marco Maccauro, MD

Permanent Staff

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Istituto di Ricovero e Cura a Carattere Scientifico Humanitas

Associate Professor, Technical Faculty “Mihailo Pupin”

University of Novi Sad

Zrenjanin, Serbia

Chief

Oncology Institute of Vojvodina

Sremska Kamenica, Serbia

Cristina Nanni, MD

Consultant

Radlink PET and Cardiac Imaging

Singapore

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Elgin Ozkan, MD

Associate Professor

Ankara University Medical School

Cebeci Research and Practice Hospital

Ankara, Turkey

Giovanni Paganelli, MD

Director

European Institute of Oncology

Milan, Italy

Christopher J Palestro, MD

Professor

Department of Nuclear Medicine and Radiology

Hofstra North Shore–LIJ School of Medicine

Hofstra University

Hempstead, New York

Chief

Division of Nuclear Medicine and Molecular Imaging

North Shore–LIJ Health System

New Hyde Park, New York

Giovanna Pepe, MD

Adrien Michael Peters, DSc, FMedSci

Professor

Department of Applied Physiology

Brighton and Sussex Medical School

Honorary Consultant

Royal Sussex County Hospital

Brighton, England, United Kingdom

Marc Peeters, MD, PhD

Professor

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Department of Medical Oncology

Professor of Molecular Imaging and Radiochemistry

Friedrich-Alexander University

Chief Radiopharmacist

Nuclear Medicine Clinic

University Hospital Erlangen

Erlangen, Germany

Gregory C Ravizzini, MD

Assistant Professor

Marcello Rodari, MD

Senior Nuclear Medicine Physician

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Pietro Rossi, NMT

Nuclear Medicine Technologist

Department of Patho-Functional Bioanalysis

Graduate School of Pharmaceutical Sciences

Kyoto University, Japan

Mink S Schinkelshoek, BSc

Student

Leiden University Medical Center

Leiden, The Netherlands

Memorial Sloan Kettering Cancer Center

New York, New York

Marta Scorsetti, MD

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Ettore Seregni, MD

Permanent Staff

Milan, Italy

Anthony Shields, MD, PhD

Professor

Department of Oncology

Wayne State University

Associate Center Director

Nuclear Medicine and Division of Diagnostic Oncology

Netherlands Cancer Institute

Amsterdam, The Netherlands

H William Strauss, MD

New York, New York

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Antwerp University Hospital

Department of Patho-Functional Bioanalysis

Graduate School of Pharmaceutical Sciences

Unit of Medical Physics

Angelo Tozzi, MD

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Istituto di Ricovero e Cura a Carattere Scientifico Humanitas

Milan, Italy

Masashi Ueda, PhD

Associate Professor

Department of Pharmaceutical Analytical Chemistry

Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayama University

Okayama, Japan

Muammer Urhan, MD

Associate Professor

Service of Nuclear Medicine

GATA Haydarpasa Hospital

Istanbul, Turkiye

Reza Vali, MD

Nuclear medicine physician

University of Toronto

Hospital for Sick Children

Richard L Wahl, MD, FACR

Professor of Radiology and Oncology

Henry N Wagner, Jr., Professor of Nuclear Medicine

Director, Division of Nuclear Medicine and PET Center

Vice Chairman for Technology and New Business Development

The Russell H Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of Medicine

Baltimore, Maryland

Tadashi Watabe, MD

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Attending Staff

Nuclear Medicine Department

Antwerp University Hospital

Department of Surgery, Division of Transplantation Surgery

Karolinska University Hospital

Stockholm, Sweden

Masahiro Yanagawa, MD, PhD

Assistant Professor

Osaka, Japan

Lucia Zanoni, MD

Fellow

Azienda Ospedaliero Universitaria di Bologna: Policlinico S Orsola-MalpighiBologna, Italy

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Pat Zanzonico, PhD

Department of Medical Physics and Radiology

New York, New York

Imene Zerizer, MBBS

Consultant Radiologist and Nuclear Medicine PhysicianNuclear Medicine and PET/CT

Royal Marsden Hospital

Visiting Assistant Professor

Harvard Medical School

Boston, Massachusetts

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Nuclear Medicine has grown at an astonishing pace When I first became involved inNuclear Medicine, imaging had just transitioned from rectilinear scanners to gammacameras; planar imaging of the brain, of perfusion and ventilation of the lung, ofcolloid uptake in the liver and spleen, of gall bladder function and renal blood flow andfunction dominated the daily nuclear medicine fare Imaging of the cardiovascularsystem was in its infancy and nuclear oncology consisted bone imaging and anoccasional gallium uptake study

The introduction of cross-sectional imaging with computed tomography (CT) and laterwith magnetic resonance imaging (MRI) profoundly transformed the field of diagnosticimaging In fact, the arrival of CT was feared to threaten the very existence of nuclearmedicine; radionuclide procedures like the many brain scans soon began to disappearfrom the daily nuclear medicine schedule as CT became clinically available

Yet, nuclear medicine has proved itself to be astoundingly resilient With singlephoton emission tomography (SPECT) and positron emission tomography (PET), nuclearmedicine joined cross-sectional imaging, yet in a unique and specific way by focusing onassays of tissue function and biology rather than on anatomy Combined with anatomicimaging with PET/CT or PET/MRI today, molecular and cellular events visualized onradionuclide images can now be localized precisely Even more importantly, as theseimages display biologic properties of anatomic alterations, hybrid function/structureimaging has gained growing clinical interest and importance Accordingly, nuclearmedicine schedules have dramatically changed Today, they are dominated byqualitative and quantitative image-based tissue assays with SPECT/CT and especiallyPET/CT for cancer diagnosis and staging, prediction of clinical outcomes, andmonitoring therapy responses, for planning radiation therapy and for identifyingtreatment targets

Nuclear medicine owes much of this change to impressive advances in cancer researchwhich have led to an improved and more detailed understanding of cancer biology,including tumor growth and angiogenesis, growth receptor function and intracellularsignaling chains, and cancer survival strategies They have also defined key regulatorysteps as potential treatment targets These advances have driven the development ofhighly targeted imaging probes for the noninvasive visualization of molecular andcellular events ranging from substrate utilization to amino acid metabolism and cellgrowth, angiogenesis and perfusion as well as cell membrane receptors regulating cellgrowth and replication Labeled with radionuclides, many of these targeted imagingprobes, tested and validated in the research laboratory, are now entering the clinicalenvironment They arm both, the nuclear medicine physician and the oncologist withspecific tools for the image-based detection of cancer, estimation of its severity andextent, prediction of tumor progression and outcome and, importantly, measurements oftherapy responses With these tools, the nuclear medicine physician participated as

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“nuclear oncologist” in the care of cancer patients.

With this book, Drs Cumali Aktolun and Stanley J Goldsmith, well-known authorities

in nuclear medicine, have enlisted many internationally known specialists to present,for the first time, a much needed comprehensive account of today’s nuclear oncology.This “inventory” of today’s nuclear oncology appropriately proceeds with a series ofreviews of organ-related malignancies and of system-wide cancers, to practical issues incancer imaging and, finally, to image-based assays of cancer biology and radionuclidetherapy Each chapter on organ-related or system-wide tumors presents the currentknowledge of molecular cancer pathogenesis and development, early tumormanifestations and tumor spread, established and emerging therapeutic strategies andclinical outcomes Advantages and limitations of diagnostic approaches are criticallyassessed, including biomarkers and image-based technologies for cancer diagnosis andstaging, for cancer recurrence and therapy response Nuclear medicine approaches likeplanar and SPECT imaging are included but applications of modern PET/CT imagingare emphasized appropriately Their utility is fully integrated with that of moreconventional imaging technologies like ultrasound, CT, and MRI for optimizing thediagnostic approach to cancer diagnosis and characterization Importantly, the

“inventory of nuclear oncology” extends into more specific topics like cancer in thepediatric population, image-based monitoring of treatment responses but also ofchemotherapy-related adverse effects, to image-based target identification and targetedradionuclide therapeutic strategies (“theranostics”) and the role of nuclear medicine inresponse-adapted treatment strategies Each topic is abundantly illustrated with highquality mostly color renditions of cancer-specific findings made with CT, MR, SPECT,and PET/CT Beyond these diagnostic radionuclide approaches largely implemented intoday’s clinical practice, the “nuclear oncology inventory” ventures into emergingapproaches and thus offers a view of what may lie ahead This prospect of the futureincludes radionuclide technologies employed primarily in the research environment butattests to future clinical possibilities for targeting specific aspects of molecular cancerbiology such as for example growth receptors, hypoxia, cell replication, angiogenesis,extracellular matrix formation, and apoptosis

The text succeeds in merging basic and clinical sciences in oncology with knowledge

in nuclear imaging and therapy As such, it is of considerable interest to both, theclinician and the imager Importantly, it is destined to intensify and broadeninteractions and collaborations between nuclear and clinical oncologists

Heinrich R Schelbert

George V Taplin

ProfessorDavid Geffen School of Medicine at UCLA

Immediate Past Editor-in-ChiefThe Journal of Nuclear Medicine

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This volume, Nuclear Oncology, is a compendium of the state of the art of NuclearMedicine procedures relevant to the current practice of Oncology, primarily diagnosticimaging and to some extent to targeted radionuclide therapy when appropriate

Over a decade ago, both of the editors of this volume had previously individuallycoedited a volume on Nuclear Oncology Since that time, a great deal of progress hasoccurred; SPECT has evolved from SPECT to SPECT/CT and PET to PET/CT; 18F-FDGPET/CT has revolutionized the practice of oncology; PET/MR has been emerging as aclinical technology; and the scope of molecular imaging has remarkably expanded to thepoint that many new molecules have gained acceptance as an imaging or therapeutictracer

It would not be an overstatement to say that 18F-FDG PET/CT is essential for thecurrent practice of oncology including the determination of the extent of disease,evaluation of treatment response, surveillance following treatment, and on someoccasions, even contributing to the diagnosis by differentiating benign from malignantlesions or at least characterizing the metabolic activity

Currently, we are on the brink of introducing into clinical practice other tracers such

as 18F-fluorocholine, 18F-fluorothymidine, and a host of 68Ga- or 89Zr-labeled molecules

to recognize specific tumor characteristics SPECT/CT is increasingly being applied toimaging single photon emission tracers, thus improving both sensitivity and specificity.Instrumentation, too, is on the brink of another giant step forward: The developmentand application of MRI/PET devices that will perform, in this case, simultaneousacquisition of MRI anatomic data and PET images of the underlying metabolic processbeing imaged depending upon the tracer

There is no doubt that image fusion increases overall accuracy; it also improves theability to communicate findings to clinicians who are not imaging specialists and tophysicians in training There has also been considerable growth in the number oftargeted radionuclide therapy agents, but the data published in this volume are limitedsince more detailed descriptions have recently been published

The editors, taking into consideration the above advances in the field of NuclearOncology, have tasked our authors to prepare reviews of the current applications of theavailable tracers using these techniques but also to include information on techniques indevelopment and, when possible, to suggest likely future developments or needs

All aspects of Nuclear Oncology including topics directly related to the practice ofOncology such as diagnostic and therapeutic radionuclide techniques are compiled in asingle volume, but experimental molecular imaging techniques and newest tracers andtechnology are also detailed in plain language, emphasizing their clinical potential infuture practice Up-to-date clinical, experimental, and technical data are presented byexpert authors practicing or researching in the subject they described in their chapters

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The volume is divided into 5 parts and 43 chapters Nineteen chapters are devoted tomalignancies involving specific organs such as the Brain, Breast, Lungs, Prostate, etc.Five additional chapters are devoted to malignancies that may be found virtuallyanywhere in the body, such as Lymphoma and Neuroendocrine Tumors In addition,there are nine chapters on special topics, such as Pediatric Tumors and Cancer ofUnknown Primaries Eight chapters are devoted to investigational aspects of TumorBiology and Molecular Imaging, such as Imaging of Multidrug Resistance, Annexin,Human Epidermal Receptors, Integrins and Hypoxia, as well as two chapters onTechnical Issues, Instrumentation, Radiochemistry, and Radiopharmaceuticals Pediatrictumors, the role of bone mineral densitometry in oncology, sentinel lymph nodeimaging, assessment of lymph node involvement, response to antineoplastic treatment,non-FDG PET/CT imaging, emerging role of PET/CT in radiotherapy planning,angiogenesis, tumor cell proliferation, and apoptosis are given special emphasis inseparate chapters All chapters are delightfully comprehensive The editors are grateful

to our chapter authors for their expertise and conscientious effort to communicate thesecomplex ideas so thoroughly and clearly

Although our past efforts were inclusive of physicians and scientists from manynations, this volume is even more diverse in the sources of expertise drawn upon toprovide readers with a view of Nuclear Oncology as it is perceived on a worldwidecanvas We are pleased also that we were able to include many younger physician-scientists who are bringing new ideas and renewed energy to research and practice ofnuclear medicine in oncology In editing the chapters as they were completed, we werepleased with the knowledge and wisdom contained in the texts and touched by theconscientious efforts of so many individuals from all around the world to providecomprehensive and authoritative reviews of the history and current status of thesediverse topics in Nuclear Oncology

Truly, we are fortunate to have been able to assemble the contributors who haveenabled us to bring this remarkable volume to our readers: Nuclear medicine andoncology physicians, scientists, and trainees We are hopeful that this volume willcontribute to further utilization of nuclear medicine diagnostic and therapeuticprocedures and to improved management and clinical outcomes in the care of patientswith malignant diseases

Stanley J Goldsmith, MD, and Cumali Aktolun, MD, MSc

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2 Head and Neck Carcinomas

Muhammad Ali Chaudhry, Lujaien Al-Rubaiey Kadhim, and Richard L Wahl

Marina Hodolicˇ and Stanley J Goldsmith

16 Uterine and Cervical Carcinoma

Berna Degirmenci Polack

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17 Ovarian Carcinoma

Marie Lacombe, Thomas Eugène, Jean-François Chatal, and Françoise Bodéré

Kraeber-18 Testicular Germ Cell Tumors

Christoph Oing, Carsten Bokemeyer, and Karin Oechsle

19 Tumors of the Adrenal Glands

Shinji Yamamoto, Per Hellman, and Anders Sundin

PART II • MALIGNANCIES INVOLVING THE ENTIRE BODY

20 Neuroendocrine Tumors

Lisa Bodei, Mark Kidd, Irvin M Modlin, and Giovanni Paganelli

21 Lymphoma and Leukemia

Jasna Mihailovic and Stanley J Goldsmith

22 Melanoma

Alice Lorenzoni, Ettore Seregni, Marco Maccauro, Andrea Maurichi, AlessandraAlessi, and Flavio Crippa

23 Neuroblastoma

Ettore Seregni, Alice Lorenzoni, Roberto Luksch, Cristina Nanni, Maria Rita

Castellani, and Emilio Bombardieri

24 Bone Tumors

Johannes Czernin and Ken Herrmann

PART III • SPECIAL TOPICS IN NUCLEAR ONCOLOGY

25 Pediatric Tumors

Reza Vali and Martin Charron

26 Cancer of Unknown Primary

Zohar Keidar, Gad Abikhzer, and Ron Epelbaum

27 Assessment of Lymph Nodes in Oncology

Ansje S Fortuin, Thomas C Kwee, Sandip Basu, Drew A Torigian, Babak Saboury,Willem M Deserno, Jelle O Barentsz, and Abass Alavi

28 Sentinel Lymph Node Detection and Imaging in Oncology

Gang Cheng, Drew A Torigian, and Abass Alavi

29 PET/CT Hybrid Imaging in Radiotherapy Planning

Egesta Lopci, Mink S Schinkelshoek, Filippo Alongi, Lidija Antunovic, Stefano

Arcangeli, Anna Maria Ascolese, Valentino Bettinardi, Francesca Lobefalo, PietroMancosu, Giovanna Pepe, Giacomo Reggiori, Marcello Rodari, Pietro Rossi,

Giovanni Tosi, Angelo Tozzi, Marta Scorsetti, and Arturo Chiti

30 Bone Mineral Densitometry in Oncology

William D Leslie

31 Non-FDG PET/CT Imaging in Oncology

Cristina Nanni, Valentina Ambrosini, Lucia Zanoni, Monica Celli, Paolo Castellucci,

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and Stefano Fanti

32 Assessment of Response to Antitumor Treatment

Masahiro Yanagawa, Noriyuki Tomiyama, Tadashi Watabe, Kayako Isohashi, andJun Hatazawa

33 Radionuclide Imaging for the Assessment of Toxicity due to Chemotherapy

Marcel P.M Stokkel and Linda de Wit–van der Veen

PART IV • INVESTIGATIVE METHODS FOR STUDYING TUMOR BIOLOGY AND MICROENVIRONMENT

34 Radionuclide Imaging of Multidrug Resistance

Sabina Dizdarevic and A Michael Peters

35 Radionuclide Imaging of Tumor Hypoxia and Its Clinical Implications

Gang Niu and Xiaoyuan Chen

36 Radionuclide Imaging of Tumor Cell Apoptosis

Paola A Erba, Chiara Manfredi, H William Strauss, and Giuliano Mariani

37 Radionuclide Imaging of Tumor Angiogenesis

Zhao-Hui Jin, Takako Furukawa, and Tsuneo Saga

38 Radionuclide Imaging of Tumor Cell Proliferation

Sridhar Nimmagadda and Anthony F Shields

39 Radionuclide Imaging of Human Epidermal Receptors

Sibaprasad Bhattacharyya, Aditya Bansal, Manish Dixit, and Timothy R DeGrado

40 Radionuclide Imaging of Integrins

Masashi Ueda, Takashi Temma, and Hideo Saji

41 Radionuclide Imaging of Annexins

Christel Vangestel, Leonie Wyffels, Marc Peeters, Steven Staelens, and Sigrid

Stroobants

PART V • TECHNICAL ISSUES

42 Radiochemistry in Nuclear Oncology

Roland Haubner and Olaf Prante

43 Advances in Nuclear and Optical Imaging of Tumors: Multi-Modality, Small-Animal,and Intraoperative Technologies

Pat Zanzonico

Index

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Part I

ORGAN MALIGNANCIES

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Neuroimaging plays a significant role in the detection of brain tumors, prediction of thehistologic grade of tumor, evaluation of the response to treatment, differential diagnosisbetween the recurrent tumor and treatment-related changes, and estimation of survivalprognosis

Magnetic Resonance Imaging

The most commonly used imaging modality is magnetic resonance imaging (MRI),which has an irreplaceable role in brain tumor imaging For evaluation of previouslyundiagnosed brain neoplasm, MRI is excellent to determine the size and location of thetumor and to demonstrate the secondary findings such as mass effect, edema,hemorrhage, necrosis, and possible signs of increased intracranial pressure

MRI has certain limitations, however, in brain tumor evaluation “Gadoliniumenhancement,” which is a basic criterion in brain tumor diagnosis by MRI, is not specificfor tumor Gadolinium enhancement is a result of blood–brain disruption, which can beseen with brain tumors as well as secondary to infectious and inflammatory etiologies

It is challenging to distinguish neoplasm from vascular, inflammatory, or otherprocesses from brain parenchymal tumors with minimal or no enhancement In tumorswith minimal or no enhancement, it is not possible to rate glial neoplasms as low gradeversus high grade Interpretation of MRI gets even more complicated in previouslytreated brain neoplasms In fact, differentiation of treatment-related changes fromrecurrent high-grade enhancing tumor and low-grade nonenhancing infiltrative tumor is

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