Beta radioguided surgery: towards routine implementation?

The Quarterly Journal of Nuclear Medicine and Molecular Imaging, vol. 65, pp. 229–243

Abstract

In locally or locally advanced solid tumors, surgery still remains a fundamental treatment method. However, conservative resection is associated with high collateral damage and functional limitations of the patient. Furthermore, the presence of residual tumor tissue following conservative surgical treatment is currently a common cause of locally recurrent cancer or of distant metastases. Reliable intraoperative detection of small cancerous tissue would allow surgeons to selectively resect malignant areas: this task can be achieved by means of image-guided surgery, such as beta radioguided surgery (RGS). In this paper, a comprehensive review of beta RGS is given, starting from the physical principles that differentiate beta from gamma radiation, that already has its place in current surgical practice. Also, the recent clinical feasibility of using Cerenkov radiation is discussed. Despite being first proposed several decades ago, only in the last years a remarkable interest in beta RGS has been observed, probably driven by the diffusion of PET radiotracers. Today several different approaches are being pursued to assess the effectiveness of such a technique, including both beta+ and beta- emitting radiopharmaceuticals. Beta RGS shows some peculiarities that can present it as a very promising complementary technique to standard procedures. Good results are being obtained in several tests, both ex vivo and in vivo. This might however be the time to initiate the trials to demonstrate the real clinical value of these technologies with seemingly clear potential.

Authors 5

1. F. Collamati corresponding

   Istituto Nazionale di Fisica Nucleare

   Affiliation as printed

   National Institute of Nuclear Physics, Rome, Italy - francesco.collamati@roma1.infn.it

   National Institute of Nuclear Physics, Rome, Italy

2. Matthias N. van Oosterom Aachen Interventional Molecular Imaging Laboratory Department of Radiology, Leiden University Medical Center

   Leiden University · Leiden University Medical Center · The Netherlands Cancer Institute

   Affiliation as printed

   Department of Urology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

   Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

3. Boris Alexander Hadaschik

   Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung

   Affiliation as printed

   Department of Urology, Essen University Hospital, Essen, Germany

   German Cancer Consortium (DKTK), Essen University Hospital, Essen, Germany

4. Pedro Fragoso Costa

   Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung

   Affiliation as printed

   Department of Nuclear Medicine, Essen University Hospital, Essen, Germany

   German Cancer Consortium (DKTK), Essen University Hospital, Essen, Germany

5. Christopher Darr

   Essen University Hospital · Deutsches Konsortium für Translationale Krebsforschung

   Affiliation as printed

   Department of Urology, Essen University Hospital, Essen, Germany

   German Cancer Consortium (DKTK), Essen University Hospital, Essen, Germany