PET IN ONCOLOGY. "THORACIC MOLECULAR IMAGING"

February 17, 2016, "N.N. Blokhin Russian Cancer Research Center", Moscow.

CONFERENCE PROGRAM

On February 17, 2016 a conference “PET in Oncology. Thoracic Molecular Imaging” was held at Blokhin Russian Cancer Research Center. Traditionally, N.N. Blokhin RCRC, Russian Association of Oncologists (RAO) and Oncological Society of Molecular Imaging (OSMI) organized it.

The Conference was attended by more than 300 participants. The issues discussed during the sessions have proved to be interesting for roentgenologists, radiologists and as well as for medical physicists, radiochemists and engineers. There were introduced reports by leading specialists from Russia, Europe and USA. The conference was accompanied by a well-structured satellite miniature exhibition where everyone could to get acquainted with new engineering solutions and production of leading international and Russian companies in molecular visualization and PET.

exhibition

The conference was organized into three sessions; the key reports were devoted to differential diagnostics, therapy response of thoracic cancer with MRI, CT-perfusion PET/CT and SPECT with various radiopharmaceuticals.

Session 1 (Chair: Shiryaev S., Dolgushin M., Tyurin I.) There were presented five reports after welcome speech of the deputy director for scientific and research activity, prof. Mikhail Lichinitser and executive director of OSMI, prof. Mikhail Dolgushin.

Mikhail Lichinitser

Mikhail Dolgushin

Session 1, Chair: I. Tyurin, S. Shiryaev, M. Dolgusin

1. I. Tyurin (Russian Medical Academy of Postgraduate, Moscow, Russia) POTENTIALITIES AND LIMITATIONS OF CT AND MRI IN LUNG CANCER DIAGNOSIS.

Chief external specialist of RF Ministry of Health in radiology raised the issue of lung cancer screening using radiological diagnosis methods, outlined existing challenges in basic methods of thoracic radiology and established the place of MRI in thoracic oncology. Prof. Tyurin told about specific of PET/CT use and its increasingly important role in differential diagnosis of lung cancer and cancer therapy response. CT remains primary method of lung cancer detecting and anatomical characterization. An advantage of MRI is in evaluation of invasion into thoracic wall, heart. PET/CT is the general method for lymphatic nodes and distant metastases estimation as well as for radiation therapy planning.

Igor Tyurin
2. Peter Kalinin (Petrov Research Institute of Oncology, Saint Pitersburg, Russia) CT-PERFUSION OF LUNG MALIGNANCIES (METODOLOGY, DIFFICULTIES, RESULTS

Ph.D. student of scientific section of Petrov Research Institute of Oncology Kalinin told about biological perfusion and CT-perfusion technical features. Peter Kalinin shared experience of CT-perfusion application in differential diagnistics of primary lung cancer, prognosis of treatment effectiveness and therapy response.

Peter Kalinin
3. Ekaterina Kobyakova (N.N. Blokhin Russian Cancer Research Center) WHOLE BODY MRI DWI IN DIAGNOSTIC OF LUNG FOCAL LESSIONS

Medical doctor in department of radiodiagnosis and intervention approach in diagnosis and therapy of N.N. Blokhin RCRC Ekaterina Kobyakova told about water diffusion in biological tissues and performed results obtained by using MR diffusion weighted Imaging in estimation of primary lung cancer. The report contained information about basic physics of the method and its benefits: high informative value, short whole body investigation time and total absence of radiation exposure. Using of this method makes possible staging of cancer in one investigation, gives information about chemoradiotherapy response. Kobyakovas impressive results indicated that MRI DWI method is promising.

Ekaterina Kobyakova and her research advisor, director of Clinical Oncology Research Institute Mikhail Davydov
4. Mikhail Plotkin (Clinic of Nuclear Medicine Charite, Berlin, Germany) SCANNING USING SPECT/CT IN DIAGNOSIS OF LUNG DISEASES

The head of nuclear medicine department in Clinic of Nuclear Medicine Charite Mikhail Plotkin has an extensive clinical experience and visit conference “PET in Oncology” regularly. This time he told about lung functions in planning of lung resection, about SPECT/CT in thromboembolia of the pulmonary artery for estimation of perfusion, lung ventilation and for determining of mucociliary clearance.

Mikhail Plotkin
5. Sergey Shiryaev (N.N. Blokhin Russian Cancer Research Center, Moscow, Russia) EMISSION TOMOGRAPHY IN THE DIAGNOSIS OF NEUROENDOCRINE TUMORS OF LUNGS AND THYMUS

The president of Oncological Society of Molecular Imaging noticed that nuclear medicine methods have to be used in diagnosis of neuroendocrine thymus cancer, because specificity of these methods is better than specificity common imaging methods in typical carcinoids and atypical low-grade carcinoids. In addition, nuclear medicine methods allow to provide whole body investigation for one-moment staging and give a possibility to predict peptide receptor radionuclide therapy response.

Sergey Shiryaev

Session 2 (Chair: Chiti A., Kairemo K. Plotkin M.) The second session consists of four reports:

Session 2, chair: K. Kairemo, A. Chiti, M. Plotkin

1. Mikhail Plotkin (Clinic of Nuclear Medicine Charite, Berlin, Germany) THE ROLE OF PET/CT IN THE DIAGNOSIS OF THORACIC ORGANS INFLAMMATORY DISEASES

In the second report Mikhail Plotkin raised a question not touched cancer radiology. Well known that 18F-FDG is not cancer specific marker, its accumulation in focuses of inflammatory process (infectious as well as non-infectious genesis). In Clinic of Nuclear Medicine Sharite 18F-FDG is used for primary diagnosis of fever with uncertain genesis and spondylodiscitis, especially when MRI is impossible (artificial cardiac valve, arterial gaft).

2. Arturo Chiti (Instituto Clinico Humanitas, Milan, Italy) PET/CT IN LUNG CANCER

2. The president of European Association of Nuclear Medicine made an overview report about the use of PET / CT in lung cancers. PET/CT with 18F-FDG plays a crucial role in N and M staging of non-small cell lung cancer and radiotherapy planning, the accuracy of radiotheraoy response needs for further development. But the role of PET with 18F-FDG in advanced non-small-cell lung cancer is insignificant. However, PET/CT with 18F-FDG is a cost effective method of management of patients with an increased risk of lung cancer.

The next part of the report was devoted to PET/CT with 68GA-DOTA-peptides in neuroendocrine types of lung cancers and carcinoids. Method is highly effective in N and M staging of neuroendocrine tumor and in the description of newly diagnosed FDG-negative nodes in lung.

The speaker also payed attention to amino acids, in particular PET/ct with thymidine in bronchial lung cancer, which is known to be FDG-negative.

Head of the department of nuclear medicine in Humanitas Institute and a practicing radiologist Professor Kitty stressed the importance of PET/CT with 18F-FDG, delayed by 2-3 hours after administration of radiopharmaceuticals in the differential diagnosis of inflammatory processes, including tuberculosis and sarcoidosis, benign and neoplastic lesions of the lung. Also there were alluded promising, but insufficiently developed in lung cancer 18F-FLT, 18F-FMISO, 11C-methionine.

Arturo Chiti
3. David Hall (Department of Nuclear Medicine Physics and Bioengineering in UH Bristol, UK) PET/CT IN DIAGNOSTIC OF MESOTHELIOMA

The head of Nuclear Medicine Physics in the (Department of Nuclear Medicine Physics and Bioengineering in UH Bristol visited a conference "PET in Oncology" he first, but hopefully not the last time. His report was devoted to diagnosis of malignant mesothelioms, wich appears frequently as a complication of asbestosis. Agriggation of PET/CT with 18F-FDG and dinamic contrast-enchanted MRI are highly efficient diagnostics methods for mesothelioms. The use of these methods and determination of conception of tumors metabolic volume and common glycolysis make estimation of therapy response easier, and initial level of 18F-FDG uptake (SUVmax) allows to specify prediction.

David Hall is a medical physicist, and he was asked about PET/CT method. Some questions didnt touch the topic of report

David Hall
4. Valentin Sinitsyn (Rehabilitation Center of Health and Social Development of Russian Federatin, Moscow) Molecular Imaging of Heart Tumors

Primary heart tumor is a rare disease (0.3% according to autopsy data) and the most frequently it is benign FDG-negative myxoma. Secondary heart tumors are more prelevant, but sometimes they include lung and mediastinum cancer invasions. Prof. Sinitsyn suggested to use threshold value SUV max>3.5 for differentiation of malignant and benign lessions. Sinitsyn thinks that PET/CT is very promissing method, but now days echo-cardiography remains the most popular method for diagnosis of primary heart tomors.

Valentin Sinitsyn

Session 3 (Chair: V. Sinitsyn, N. Kostenikov, S. Shiryaev) consists of four reports:

Session 3, chair: V. Sinitsyn, N. Kostenikov, S. Shiryaev

1. Aleksey Subbotin (Center of Positron Emission Tomography in Chelyabinsk Regional Oncological Hospital, Russia) PET/CT IN DIAGNOSIS OF ASOPHAGUS TUMORS

Practicing radiologist Subbotin Alexei reported results of the study based on FDG-PET/CT of 81 patients with tumor and inflammatory changes of the esophagus, held in Chelyabinsk Regional Oncological Hospital. Differential diagnosis of esophageal cancer and benign tumors can be based on SUVmax, because the benign tumors tend to be metabolically inactive, however, in rare cases, esophageal cancer characterized by low metabolic activity, and benign formations may have a high metabolic rate.

It is not possible to set accurate differential diagnosis of esophagitis and esophageal cancer only by SUVmax, as well as to distinguish cancer differentiation grade.

Aleksey Subbotin
2. Nadezhda Meshcheryakova (N.N. Blokhin Russian Cancer Research Center, Moscow, Russia) THE ROLE OF FDG PET/CT IN EVALUATION OF TREATMENT EFFECTIVENES IN NSCLC

Meshcheryakova Nadezhda, PhD student of Clinical and Experimental Radiology Research Institute, presented preliminary results of study (research supervisor professor Dolgushin M.) on role of 18F-FDG PET in assessment of response in non–small cell lung cancer. Comparison of RECIST and PERCIST for evaluation of early response to radiochemotherapy has expectedly shown that PET/CT is more sensitive and accurate than CT for the detection of an early therapeutic response in patients with non-small-cell lung cancer. Subject has caused genuine interest among the audience and among the speakers - issues related to the study design and standardization was discussed.

Nadezhda Meshcheryakova
3. Kalevi Kairemo (Department of Nuclear Medicine in Univercity of Texas, Huston, USA) FLT-PET IN THE EARLY RESPONSE EVALUATION OF TORACIC MALIGNANCIES

Dr. Kairemo (Visiting Professor in Department of Nuclear Medicine The University of Texas) was talking about fluorothymidine and its potential utility for noninvasively measuring cellular proliferation in vivo in malignant tumors PET/CT. This technology could have exciting implications in oncology, including the possibility of assessing tumor grade and aggressiveness. FLT-PET could also be used to predict and monitor response to antitumor therapies, especially early in the course of treatment of lung cancer, esophageal cancer breast and colorectal cancer. Professor Kairemo reminded the audience differences in thymidine and 18F-fluorothymidine metabolism.

In lung cancer FDG is the more sensitive tracer (81% vs. 95%), whereas FLT may be the more specific for malignancy (70% vs. 50%) – so it is not possible to use only FLT in primary diagnosis of lung cancers, but allows to differentiate areas of inflammation and neoplastic infiltration in the large tumors. Therefore, in lung cancer, FLT-PET combined with FDG-PET could potentially improve the specificity of staging and provide information regarding tumor growth rate and aggressiveness which could impact prognosis and/or treatment selection. In primary esophageal cancers FLT-PET compared with FDG-PET gives more false-negative and less false-positive findings. This allows to assess the effect of therapy in initially active tumors, but there is not a significant positive correlation between FLT uptake and cellular proliferation. Dr. Kairemo, fs a practicing physician of Cancer Center, outlined the good prospects of FLT-PET/CT by clinical cases of thorax angiosarcomas.

Kalevi Kairemo
4. Pierre Vera (Head Department medical imaging & nuclear medicine, Deleguate Director for Research CLCC Henri Becquerel, Rouen, France) THE INTEREST OF PET FOR EXTERNAL RADIOTHERAPY IN LUNG CANCER

Dr. Pierre Vera (Department of Nuclear Medicine, Henri Becquerel Centre and Rouen University Hospital), in its report identified the role of PET/CT in the planning and evaluation of treatment response in lung cancer. Today, FDG-PET/CT is the gold standard in the planning of external beam radiotherapy for lung cancer, but using PET-CT to define areas for simultaneous integrated boost is not a routine. The use of various tracers to assess the primary tumor hypoxia at different stages of radiotherapy is actively discussed. Respiratory-gated PET/CT allows more accurate identification of tracer uptake and tumor volume. Professor Vera suggested combined algorithm of FDG- and FMISO-PET/CT use for radiotherapy planning and boost correction in lung cancer. This protocol of maximum radiation dose calculation possible to reduce tumor volumes up to 59% tree month after radiation therapy (further control has not yet been carried out). The speaker also touched upon the issues of radiation therapy of esophageal cancer and metastases of other oncological processes.

Pierre Vera

Almost all reports emphasized the increasing by light of experience role of PET/CT in the staging and treatment assessment of malignant tumors. Conference participants agreed in opinion about the optimal multi-modal approach in the diagnosis of neoplastic diseases of thoracic organs. The fourth conference in 2017 decided to devote to molecular imaging of head and neck cancer.