JOSE FLAVIO GOMES MARIN
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- Theranostics in Nuclear Medicine: Emerging and Re-emerging Integrated Imaging and Therapies in the Era of Precision Oncology(2020) MARIN, Jose Flavio Gomes; NUNES, Rafael F.; COUTINHO, Artur M.; ZANIBONI, Elaine C.; COSTA, Larissa B.; BARBOSA, Felipe G.; QUEIROZ, Marcelo A.; CERRI, Giovanni G.; BUCHPIGUEL, Carlos A.Theranostics refers to the pairing of diagnostic biomarkers with therapeutic agents that share a specific target in diseased cells or tissues. Nuclear medicine, particularly with regard to applications in oncology, is currently one of the greatest components of the theranostic concept in clinical and research scenarios. Theranostics in nuclear medicine, or nuclear theranostics, refers to the use of radioactive compounds to image biologic phenomena by means of expression of specific disease targets such as cell surface receptors or membrane transporters, and then to use specifically designed agents to deliver ionizing radiation to the tissues that express these targets. The nuclear theranostic approach has sparked increasing interest and gained importance in parallel to the growth in molecular imaging and personalized medicine, helping to provide customized management for various diseases; improving patient selection, prediction of response and toxicity, and determination of prognosis; and avoiding futile and costly diagnostic examinations and treatment of many diseases. The authors provide an overview of theranostic approaches in nuclear medicine, starting with a review of the main concepts and unique features of nuclear theranostics and aided by a retrospective discussion of the progress of theranostic agents since early applications, with illustrative cases emphasizing the imaging features. Advanced concepts regarding the role of fluorine 18-fluorodeoxyglucose PET in theranostics, as well as developments in and future directions of theranostics, are discussed. (C) RSNA, 2020
- Prostate-specific Membrane Antigen PET: Therapy Response Assessment in Metastatic Prostate Cancer(2020) BARBOSA, Felipe G.; QUEIROZ, Marcelo A.; FERRARO, Daniela A.; NUNES, Rafael F.; DREYER, Priscilla R.; ZANIBONI, Elaine C.; COSTA, Larissa B.; BASTOS, Diogo A.; MARIN, Jose Flavio G.; BUCHPIGUEL, Carlos A.Therapy response assessment is a critical step in cancer management, leading clinicians to optimize the use of therapeutic options during the course of the disease. Imaging is a pivotal biomarker for therapy response evaluation in oncology and has gained wider use through the development of reproducible data-based guidelines, of which the Response Evaluation Criteria in Solid Tumors is the most successful example. Disease-specific criteria have also been proposed, and the Prostate Cancer Working Group 3 criteria are the mainstay for prostate cancer (PC). However, conventional imaging evaluation in metastatic PC has several limitations, including (a) the inability to detect small-volume disease, (b) the high prevalence of bone (nonmeasurable) lesions at imaging, and (c) the established role of serum prostate-specific antigen (PSA) levels as the biomarker of choice for response assessment and disease progression. In addition, there are an increasing number of newer treatment options with various effects on imaging features. Prostate-specific membrane antigen (PSMA) PET has improved patient selection for newer treatments, such as metastasis-directed therapy (MDT) or radionuclide therapy. The role of PSMA PET in response assessment for many metastatic PC therapeutic options (MDT) androgen deprivation therapy, chemotherapy, radionuclide therapy, and immunotherapy) is an evolving issue, with emerging data showing good correlation with PSA levels and clinical outcome. However, there are specific implications of each therapy (especially androgen deprivation therapy and immunotherapy) on PSMA expression by PC cells, leading to potential pitfalls and inaccuracies that must be known by radiologists. Despite some limitations, PSMA PET is addressing gaps left by conventional imaging methods (eg, CT and bone scanning) and nonimaging biomarkers (PSA levels) in metastatic PC therapy response assessment, a role that can be improved with advances like refinement of interpretation criteria and whole-body tumor burden quantification. (C) RSNA, 2020
- Burden of metastatic bone disease measured on F-18-NaF PET/computed tomography studies as a prognostic indicator in patients with medullary thyroid cancer(2020) UEDA, Cristina E.; DUARTE, Paulo S.; CASTRONEVES, Luciana A. de; MARIN, Jose Flavio G.; SADO, Heitor N.; SAPIENZA, Marcelo T.; HOFF, Ana O.; BUCHPIGUEL, Carlos A.Purpose The aim of the study was to assess the association between the burden of metastatic bone disease measured on F-18-NaF PET/computed tomography (CT) studies and the overall survival (OS) of patients with medullary thyroid cancer (MTC). Methods We retrospectively analyzed 31 patients with MTC who performed 18F-NaF PET/CT studies to assess skeletal metastases. The outcomes of the patients (dead or alive) were established based on the last information available on their files. In the studies considered positives for skeletal metastases, the burden of metastatic bone disease was established calculating the fluoride tumor volume (FTV). The FTV was defined using isocontour thresholds based on percentages of maximal standardized uptake values (SUVmax) in the lesions. These percentages varied from lesion to lesion and were established by visual analysis. The patients were divided into three groups as follows: without skeletal metastases (n = 11), with low FTV (<= 50 cm(3); n = 11) and with high FTV (>50cm(3); n = 9). The Kaplan-Meier curves were used to analyze the OS in the three groups of patients and the log-rank test was used to determine the statistical significance of the difference between the groups. Results There were statistically significant differences in the OS between the group with high FTV and the groups of patients with low FTV (P = 0.036) and without skeletal metastases (P = 0.001). There was not a statistically significant difference between the groups of patients with low FTV and without skeletal metastases (P = 0.147). Conclusion In patients with MTC, the burden of metastatic bone disease is associated with OS.