Preliminary results of a 68 Ga-PSMA PET/CT prospective study in prostate cancer patients with occult recurrence: Diagnostic performance and impact on therapeutic decision-making.

BACKGROUND: In this prospective study (NCT03443609), we investigated the impact of 68Ga-PSMA-11 PET-CT on the treatment plan and therapeutic response obtained for patients with prostate cancer (PCa) presenting a recurrence with a low rising PSA. METHODS: One hundred thirty hormone-naive (PSA < 1.5 ng/mL) patients were enrolled. All patients received radical treatment. PET images were recorded 1 and 2 hours after injection of tracer and interpreted by two independent nuclear physicians. Six months after treatment ended, a PSA assay was requested to evaluate the therapeutic efficacy of the treatment based on PSMA results. RESULTS: Data analysis for the first 52 included patients has been completed. 68Ga-PSMA-11-positive lesions were detected in 38/52 (73.1%) patients. Ninety-four lesions were detected as follows, 53/94 in lymph nodes (56.4%), 25/94 in bone (26.6%), and 12/94 into the prostate bed (12.7%). Detection rates were 58%, 81%, and 82% for serum PSA levels lower than 0.25 ng/mL, between 0.25 to ≤ 0.69 ng/mL and 0.70 ng/mL, respectively. As a result of the PSMA PET-CT, therapeutic management changed in 38/52 patients (73.1%). Patients had undetectable serum PSA levels after treatment guided by 68Ga-PSMA-11 PET-CT results in 10/52 (19.2%) cases and with a PSA decrease of over 60% in 18/52 (34.6%) patients. CONCLUSION: Whilst our patient population presented a very low PSA level, preliminary results of the 68Ga-PSMA PET-CT study showed recurrence localization in more than half of the patients and this had a major clinical impact, as it resulted in treatment change in more than half of the patients and a significant decrease in PSA levels in a third of patients.

Effective Management of 177Lu-DOTA0-Tyr3-Octreotate Extravasation.

ABSTRACT: Radiopharmaceutical extravasation is a known nuclear medicine adverse effect, mostly with no complication in case of diagnostic radiopharmaceutical. However, a therapeutic radiopharmaceutical extravasation may have clinical consequences and must be treated quickly and effectively. We report here a case of 177Lu-DOTA0-Tyr3-octreotate extravasation.

THE RADIOBIOLOGICAL PLATFORM AT ARRONAX.

The cyclotron ARRONAX can deliver different types of particles (protons, deuterons, alpha-particles) in an energy range up to 68 MeV. One of its six experimental halls is dedicated to studying the interactions of radiation with matter including living matter. A horizontal beamline for cell irradiation has been setup and characterized. The radiobiological characterization was done in terms of V79 cells survival after irradiation with 68 MeV protons. The results demonstrate that radiobiological studies can be successfully performed confirming the high potential of the facility.

Energies, stability and structure properties of radicals derived from organic sulfides containing an acetyl group after the *OH attack: ab initio and DFT calculations vs experiment.

The mutual location of the sulfur atom and the acetyl group was found to affect significantly the (*)OH-induced oxidation mechanism of the organic sulfides containing either an alpha- or beta-positioned acetyl group. This phenomenon was reflected in formation of different intermediate products observed in pulse radiolysis experiments (Varmenot et al. J. Phys. Chem. A. 2004, 108, 6331-6346). In order to obtain a better support for the earlier interpretation of the experimental data, quantum mechanical calculations were performed using a density functional theory method (DFT-B3LYP) and the ab initio method (Møller-Plesset perturbation theory MP2) for optimizations and energy calculations of the parent molecules and radicals and radical cations derived from them. In accordance with experiments, it was found that the alpha-positioned acetyl group in S-ethylthioacetate (SETAc) destabilizes hydroxysulfuranyl radicals and monomeric sulfur radical cations. Instead, formation of stable C-centered radicals of the alpha-(alkylthio)alkyl-type was found energetically favorable, the H3C-(*)CH-S-C(=O)CH3 radical, in particular. On the other hand, the beta-positioned acetyl group in S-ethylthioacetone (SETA) does not destabilize hydroxysulfuranyl radicals, monomeric sulfur radical cations, and dimeric sulfur radical cations. Moreover, the alpha-(alkylthio)alkyl radicals of the type -S-(*)CH-C(=O)- were found to be particularly stabilized. The calculated transition states pointed toward the efficient direct conversion of the hydroxysulfuranyl radicals derived from SETAC and SETA radicals into the respective C-centered radicals. This reaction pathway, important in neutral solutions, is responsible for the absence of the dimeric radical cations of SETAc at low and high concentrations and of the dimeric radical cations of SETA at relatively low concentrations of the solute.

Alpha-emitters for immuno-therapy: a review of recent developments from chemistry to clinics.

Alpha-particles are of considerable growing interest for Targeted Alpha Therapy (TAT). TAT gains more attention as new targets, chemical labeling techniques and α-particle emitters are developed but translation of TAT into the clinic has been slow, in part because of the limited availability and the short physical half-lives of some of the available α-particle emitters. This article is an up-to-date overview of the literature concerning α-emitters used for TAT of cancer. It briefly describes the nuclear characteristics, the production parameters (targets, extraction and purification), the complexation properties of these radionuclides to chelates and biological vectors and finally draws-upon the preclinical and clinical studies that have been performed over the past two decades. Radiobiology and dosimetry aspects are also presented in this paper.

Evaluation of a rigid registration method of lung perfusion SPECT and thoracic CT.

OBJECTIVE: The objective of our study was to evaluate a rigid registration method in lung perfusion SPECT using thoracic CT as a standard. MATERIALS AND METHODS: The reproducibility of markers selection and the robustness of the method were assessed on a torso phantom. The accuracy of registration regarding the number and location of markers and the breathing state during CT was evaluated on eight patients using 10 external markers placed around the thorax before SPECT and CT acquisitions. The accuracy of registration was assessed using the mean errors (ME) between 10 markers after registration. RESULTS: Registration using external markers on a phantom was accurate (ME, < 3 mm) when rotation was less than 40 degrees (p = 0.02). The accuracy of registration improved markedly from four to six markers for phantom (5.5-3.6 mm) and patients (11.2-9.5 mm) and then remained constant up to 10 markers. The ME was less when using markers that well encompassed the thorax for phantom and patients (p = 0.02 and p = 0.05, respectively). The use of four anatomic markers was not accurate (ME, 20 mm). CONCLUSION: The registration method is reproducible and accurate, and six external markers were required to get an ME of less than 10 mm in patients.