Oncology

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The important roles that nuclear medicine plays in oncology concern both scintigraphic techniques (with either single-photon or positron-emitting radiopharmaceuticals) and therapy with tumour-seeking agents labelled with adequate radionuclides.

Most of the applications of either conventional (single-photon) scintigraphy or positron emission tomography (PET) do not concern primary diagnosis (i.e., discriminating a suspect lesion as either tumour or non-tumour, or distinguishing the different types of tumours), but rather characterization of the patients after diagnosis of cancer has been established; such characterization is crucial at several stages of clinical management. Immediately after diagnosis, any patient with cancer must be correctly staged in order either to gain prognostic indications and/or to select the most appropriate treatment(s) (surgery, adjuvant or neo-adjuvant therapy, combined regimens). In this scenario, metabolic-functional characterization provided by radionuclide imaging (especially if employing PET) is generally superior to pure morphologic imaging; nevertheless, caution should be adopted regarding high sensitivity but relatively low specificity in some instances. Radionuclide imaging is useful to localize tumour lesions also in the perspective of image-guided and/or intra-operative probe-counting-guided surgery for either tumour debulking purposes or for directing diagnostic biopsy. Metabolic-functional characterization is also important for assessing the efficacy of anti-tumour therapy as well as, during follow-up, for distinguishing abnormalities noted on morphologic imaging as due to either nonspecific post-treatment changes or to tumour recurrence. In all these applications (as well as for integrating regional metabolic information in radiotherapy planning) the highest clinical benefit is achieved by relying on tomographic imaging (SPECT or PET), preferably with hybrid image fusion analysis (SPECT/CT or PET/CT).

The therapeutic applications of nuclear medicine are now expanding from a core of well-established procedures (such as radioiodine therapy in differentiated thyroid cancer, palliation of bone pain from skeletal metastases using bone-seeking agents, therapy of neuroblastoma or pheochromocytoma with 131I-MIBG) to newer applications covering a wider range of treatable malignacies (such as radioimmunotherapy of lymphomas and other malignancies, receptor-mediated therapy of neuroendocrine tumours with radiolabeled somatostatin analogues, etc).