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The Role of Positron Emission Tomography(PET) in Radiation Treatment Planning.

Hanyang Medical Reviews.2007;27(4):76-85.

Molecular imaging, in particular, positron emission tomography(PET) has brought an additional dimension to management for patients with cancer. It may lead to a change in staging and treatment management. In radiotherapy, the PET or PET-CT has a crucial role in treatment planning and patient management, specifically, its use in disease staging, patient selection, treatment planning and evaluation. The purpose of radiotherapy is radical or palliative depending on the staging of tumor; thus, PET(-CT) may actually change the course of disease. The methodological and technological aspects of PET(-CT) in radiotherapy are discussed, focusing on the problem of target volume definition and tumor motion with respect to imaging and dose delivery. In addition, tissue hypoxia is an important factor in radiotherapy as a resistance factor in treatment; thus, we mention the concept of hypoxia-directed therapy.
Anoxia ; Electrons* ; Humans ; Molecular Imaging ; Patient Selection ; Radiotherapy

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The Clinical Role of FDG PET in Malignant Lymphoma.

Gi Jeong CHEON

Hanyang Medical Reviews.2007;27(4):66-75.

FDG PET is a functional and metabolic imaging modality to detect lesions with altered glycolytic activity. Conventional imaging modalities, such as CT or MRI, provide tissue information based on anatomical and physiological changes. In most cases of malignant lymphoma, malignant cells have up-regulated glycolytic activity and increased uptake of FDG, an analogue of glucose. FDG PET can detect change in FDG uptake in lesions of malignant lymphoma and may be advantageous to differentiate malignant lesions from other non-malignant tissues over the conventional methods. For these reasons, FDG PET has become popular as a new imaging modality to diagnose many kinds of malignant tumors. FDG PET has a major impact on management of patients with malignant lymphoma in the differentiation of malignant lesions, monitoring the therapeutic response, and identifying the non-responders who could benefit from a different therapeutic strategy. At present, FDG PET appears to be one of the promising imaging modalities in the management of patients with ymphoma.
Glucose ; Humans ; Lymphoma* ; Magnetic Resonance Imaging

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PET Imaging for Gynecologic Malignancy.

Kyoung Sook WON

Hanyang Medical Reviews.2007;27(4):59-65.

The utility of positron emission tomography (PET) in gynecologic malignancy has increased rapidly in recent years. This review examines publications in this area. PET scans in gynecologic malignancy are mostly performed using F-18 FDG. It is valuable in primary staging of untreated advanced cervical cancer, for post-treatment unexplained tumor marker elevation, and restaging of potentially curable recurrent cervical cancer. However, its value in early-stage cervical cancer is limited. In ovarian cancer, sequential imaging predicts response to neoadjuvant chemotherapy and survival. It is also very useful when increases in CA 125 or CT/MRI defined recurrence is noted, but biopsy deemed infeasible. The role of PET or PET/CT has evolved from a iagnostic tool into a potential indicator of response to treatment and prognosis. Evaluating PET or PET/CT using clinical impact is an attractive new endpoint.
Biopsy ; Drug Therapy ; Ovarian Neoplasms ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Prognosis ; Recurrence ; Uterine Cervical Neoplasms

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The role of Positron Emission Tomography in hepatobiliary cancers.

Mijin YUN

Hanyang Medical Reviews.2007;27(4):52-58.

Imaging approach for early diagnosis, accurate staging, and the evaluation of treatment response has been consisted of anatomical and functional imaging methods. The anatomical image usually depends on high spatial resolution to distinguish morphological difference from normal anatomy, but altered anatomy is not a specific finding for malignancy. Moreover, it frequently needs other imaging modalities for systemic evaluation of disease. The functional image has been used for research and clinical purpose to overcome these shortcomings of the anatomical image, and the importance of functional evaluation of tumors is widely accepted by the introduction of Positron Emission Tomography (PET). Most of the PET systems at present are supplied as PET/CT combining functional and anatomical images, altogether. Especially for hepatobiliary tumors, showing a low sensitivity by PET alone, PET/CT will play an important role in determining TNM stage, deciding treatment modality, and evaluating treatment response. In addition, PET/CT as the most advanced molecular image technique has further growing potentials such as the development of a faster PET system, various new PET tracers, etc, which will contribute to improving patient survival and the quality of life.
Bile Duct Neoplasms ; Carcinoma, Hepatocellular ; Early Diagnosis ; Electrons* ; Humans ; Positron-Emission Tomography and Computed Tomography ; Positron-Emission Tomography* ; Quality of Life

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The Role of fluorodeoxyglucose PET in the management of breast cancer.

Won Hyoung LEE ; Ie Ryung YOO

Hanyang Medical Reviews.2007;27(4):43-51.

In breast cancer, FDG PET is more accurate than conventional imaging methods for detecting distant metastases or local recurrences, and enables early ssessment of treatment response in patients undergoing primary chemotherapy. Though FDG PET has limited sensitivity in detecting tumor of small size, well differentiated tumor or lobar carcinoma, and regional lymph node metastasis, FDG PET is useful in cases with obscure MR images and axillary lymph node metastasis in locally advanced breast cancer. To minimize the side effects and cost of chemotherapy, imaging methods are required to monitor theresponse to chemotherapy, early and accurately. FDG PET is the appropriate method for this purpose. We reviewed the role of FDG-PET in diagnosis and initial staging of breast cancer, monitoring response to chemotherapy, and identifying metastatic and recurrent disease.
Breast Neoplasms* ; Breast* ; Diagnosis ; Drug Therapy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence

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PET oncology; Lung cancer.

Won Woo LEE

Hanyang Medical Reviews.2007;27(4):37-42.

Lung cancer constitutes non-small cell lung cancer and small cell lung cancer. Positron emission tomography (PET) using F-18 labelled fluoro-deoxy glucose (FDG) has been evolving from a promising diagnostic tool in selective patients to an essential routine procedure in almost all lung cancer patients. Glucose transporter type 1 (Glut-1) plays a major role in determining FDG uptake in lung cancer, and immunoreactivity of Glut-1 reveala a high correlation with standardized uptake value (SUV) of FDG in primary tumor and metastatic lymph nodes of lung cancer. This review article aims to onsolidate the understanding of the role of FDG-PET in the management of lung cancer
Carcinoma, Non-Small-Cell Lung ; Glucose ; Glucose Transport Proteins, Facilitative ; Glucose Transporter Type 1 ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Positron-Emission Tomography ; Small Cell Lung Carcinoma

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Clinical Application of F-18 FDG PET/PET-CT in gastrointestinal tumors.

Yun Young CHOI

Hanyang Medical Reviews.2007;27(4):28-36.

Positron emission tomography (PET) is a functional imaging modality which has been documented to be useful in clinical oncology. Oncologic PET imaging has been used for a wide variety of tumors, mainly for staging, follow up, differentiation of equivocal morphologic findings, therapy stratification, monitoring, and prediction of prognosis. PET imaging is based on the physiologically mediated distribution of administered radiotracers. F-18 FDG is the ost commonly used radiotracer in oncologic PET, which reflects the overt expression of glucose tranporter Glut-1 on the cell membrane. This article ocuses on gastric adenocarcinomas,a brief note about gastrointestinal stromal tumors (GIST) and colorectal cancer.
Cell Membrane ; Colorectal Neoplasms ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Glucose ; Medical Oncology ; Positron-Emission Tomography ; Prognosis

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The Use of PET in Esophageal Cancer.

Joon Young CHOI

Hanyang Medical Reviews.2007;27(4):23-27.

Esophageal cancer is one of the gastrointestinal malignancies that have an unfavorable prognosis. Whole body positron emission tomography (PET) using F-18 Fluorodeoxyglucose (FDG) has been used for characterizing focal lesions, initial staging, monitoring recurrence, and post-therapeutic follow-up in arious malignant tumors. In esophageal cancer, FDG PET is not used for characterizing esophageal focal lesion. Due to better results for initial staging of esophageal cancer than chest CT or endoscopic ultrasound, especially in N and M staging, FDG PET provides valuable information for assessing prognosis and for selecting appropriate treatment. Although several studies are reported, FDG PET may be useful for restaging and detection of recurrence in esophageal cancer. For predicting pathological response to neoadjuvant therapy, FDG PET has been showed good results. Like other alignancies, integrated PET/CT is preferable to conventional PET in esophageal cancer considering better anatomical localization of hypermetabolic esions and accuracy.
Esophageal Neoplasms* ; Esophagus ; Follow-Up Studies ; Neoadjuvant Therapy ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Prognosis ; Recurrence ; Tomography, X-Ray Computed ; Ultrasonography

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Clinical Application of PET in Head and Neck Cancer.

Jae Seung KIM ; Jai Hyuen LEE

Hanyang Medical Reviews.2007;27(4):16-22.

Head and neck cancers are the sixth most common type of human cancer worldwide. Squamous cell carcinomas are the most common cancer of the head and neck. Due to the higher glycolytic rates of squamous cell carcinomas relative to normal tissue, the glucose analog 18F-FDG can be used to detect umors, and 18F-FDG PET has been used inpatients with head and neck cancers for initial staging, management of recurrent cancers, and therapeutic onitoring. We reviewed the clinical application and diagnostic usefulness of 18F-FDG PET in the management of head and neck cancer.
Carcinoma, Squamous Cell ; Fluorodeoxyglucose F18 ; Glucose ; Head and Neck Neoplasms* ; Head* ; Humans ; Inpatients ; Neck

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New Trend of tumor PET imaging radiopharmaceuticals.

Seung Jun OH

Hanyang Medical Reviews.2007;27(4):4-15.

Tumor PET imaging with radiopharmaceuticals plays a major role in the understanding of tumor biological information and for diagnosis of tumorswith non-invasive methods. These radiopharmaceuticals can be divided into two categories radiopharmaceuticals for metabolic process imaging and for specific receptor imaging. Most tumor imaging radiopharmaceuticals such as [18F]FDG, [18F]FLT, and [11C]choline can be trapped in tumor cells by specific metabolic processes of each radiopharmaceutical and show an increase in metabolism of tumor regions. Unlike these compounds, the hypoxia imaging adiopharmaceuticals such as [18F]FMISO and [64Cu]ATSM are trapped by oxidative metabolic mechanisms under only hypoxic conditions of tumor cells. For tumor specific receptor imaging, [18F]FES for estrogen receptor positive breast cancer may be used and recent clinical results showed the possibility of evaluating tumor therapy responseby estrogen receptor imaging with [18F]FES. This paper gives an overview of the current status of tumor PET imaging adiopharmaceuticals and the development of new lead compounds as potential radiopharmaceuticals by medicinal chemistry.
Anoxia ; Breast Neoplasms ; Chemistry, Pharmaceutical ; Diagnosis ; Estrogens ; Metabolism ; Radiopharmaceuticals*

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