30-Second Takeaway
- PET-guided, dose-escalated salvage RT after prostatectomy improves 2-year event-free survival, with similar benefit from fluciclovine and PSMA tracers.
- FDG PET/CT substantially increases recurrence detection sensitivity in NSCLC surveillance, particularly early and after chemoradiotherapy.
- FAPI and FDG PET provide complementary information for RT response prediction and planning in esophageal and head and neck cancers.
- Dosimetry-guided PRRT and novel targets like ACP3 support more individualized radionuclide therapy strategies in NETs and prostate cancer.
- Standardized PET-based response frameworks are reshaping assessment for PSMA imaging and Radium-223 beyond traditional serum biomarkers.
Week ending December 20, 2025
Targeted PET and theranostics to refine oncologic imaging and radionuclide therapy
PET-guided dose-escalated salvage radiotherapy improves short-term outcomes post-prostatectomy
EMPIRE-2 randomized men with biochemical progression after prostatectomy to [18F]-fluciclovine or [68Ga]-PSMA-11 PET-guided salvage radiotherapy. Dose escalation to PET-avid sites in the bed and pelvis was allowed up to 76 Gy and 56 Gy, respectively. Overall 2-year event-free survival was higher than in EMPIRE-1 without dose escalation, including propensity weighting (84% vs 73%; p = 0.01). Event-free survival was nearly identical between fluciclovine and PSMA-11 arms, indicating either tracer is suitable for PET-guided escalation.
FDG PET/CT increases sensitivity for NSCLC recurrence surveillance compared with CT alone
This secondary analysis of the SUPE_R randomized trial compared FDG PET/CT with CT for recurrence surveillance after curative-intent NSCLC treatment. Across 692 patients, PET/CT showed higher sensitivity than CT for recurrence detection (88% vs 62%) but lower specificity (89% vs 96%). Sensitivity gains were greatest after chemoradiotherapy and during the first 6 months post-treatment, when CT frequently missed recurrences. The authors suggest reserving PET/CT for high-risk scenarios, while CT may remain the standard for routine low-risk surveillance.
Dual-tracer FAPI and FDG PET predict response and PFS in locally advanced esophageal SCC
This study evaluated baseline and post-neoadjuvant chemoradiotherapy 68Ga-FAPI and 18F-FDG PET/CT in 49 locally advanced esophageal squamous cell carcinoma patients. A combined clinical plus baseline and post-treatment FAPI model best predicted pathologic tumor regression grade, with AUC 0.95. Clinical plus post-treatment FDG features best predicted progression-free survival, with C-index 0.93, outperforming clinical-only models. FAPI heterogeneity and BMI independently predicted pathologic response, while clinical stage and FDG distribution features predicted progression risk.
Interim DUONEN data support safety of dosimetry-guided and tandem 177Lu/90Y PRRT
DUONEN randomizes advanced GEP-NET patients to fixed-activity 177Lu-DOTATATE or three dosimetry-guided 177Lu/90Y or variable-177Lu regimens. Cycle-by-cycle organ dosimetry guided activity adjustments to keep kidney doses below 23 Gy and marrow doses below 2 Gy. Interim analysis of 56 patients showed frequent dose reductions in tandem 177Lu/90Y arms and dose escalations in variable 177Lu monotherapy. Median kidney and marrow doses remained acceptable, renal function stayed stable, and hematologic declines correlated with marrow dose yet were manageable.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.