ECCO Quality Cancer Care Week
EANM Congress: joint sessions to improve collaboration for cancer patients
The yearly Congress of the EANM is the most attended event of the specialty worldwide. It is the inherent nature of Nuclear Medicine to be collaborative, given that the specialty aims at supporting the referring clinicians, and especially oncologists in diagnosis and treatment of their patients. For these reasons, a number of sessions is jointly organized with the most prominent professional societies in oncology and related fields, such as ECCO, EORTC, ESTRO, EAU, ESMO, ELI, IASLC and ISNS. This allows a fruitful exchange between professional, thereby promoting the collaboration between them, toward better cure for the patient through the whole patient journey.
PET imaging to guide Radiation Therapy
Radiation Therapy is well known to be one of the most successful approaches to treat a number of malignancies. In recent years’ new devices have allowed Radiation Therapy to increase response rate and reduce toxic effects, thus becoming even more effective. PET imaging is a reliable tool to guide the Radiation Therapy, and in particular to properly design the treatment volumes: by identifying the areas of active viable tumor, PET enables to exactly drive the Radiation Therapy dose where necessary. The use of PET with FDG for guiding Radiation Therapy has already been established in many malignancies, including Head and Neck cancers, Lung cancers, Uterine cancers. Furthermore, the use of PET with other tracers is under evaluation to guide Radiation Therapy also for other fields, such as Prostate cancer. This means that nuclear medicine procedures improve the cancer care for patient by enhancing the efficiency of cancer treatments.
Nuclear Medicine procedures to evaluate response to therapy
Nuclear Medicine is the most validated method of molecular imaging at present. The use of functional imaging is well known to be particularly reliable in many situations when it is crucial to evaluate the response to therapy; in cancer patient such characteristic may be particularly relevant. A paradigmatic example is the use of PET to evaluate the response to therapy in hematological malignancies: lymphomas are well known to be potentially curable with pharmacological therapies, but it is mandatory to discriminate as soon as possible the patients who benefit from a treatment from those who require a different therapy to. In such setting, conventional morphological imaging has frequently a limited value, while PET has demonstrated to have a major clinical role, and it is commonly used in patients with lymphoma. Such concept has been extended to many other solid tumors, where PET is used to early assess the response to therapy. PET results can be used to stop treating patients which are not benefitting from therapy, thus avoiding side effects and costs. Thereby, nuclear medicine procedures help in choosing the most effective treatment for patients with cancer.
Quality programmes in nuclear medicine: better tools for the benefit of all cancer patients
A decade ago the EANM launched an initiative to promote multicenter nuclear medicine and research, the EANM Research Ltd (EARL). EARL was created to unleash the power of molecular imaging and to promote several other goals, such as to improve nuclear medicine and its practice; to provide a basis for discussion and the exchange of cutting edge ideas; to act as a contact point for researchers as well as for clinicians and business leaders; to provide a platform for the efficient pursuit of scientific initiatives; to facilitate multicenter research projects; to boost molecular imaging so that it becomes a standard diagnostic modality in future clinical medicine and research. Among these activities, it has become particularly relevant to streamline efforts towards developing tools to standardize the results of nuclear medicine procedures, with the aim of enhancing the comparability of data acquired by molecular imaging. The EANM is committed to harmonization and standardization of nuclear medicine throughout Europe for the benefit of the patients.
PSMA: innovation for imaging and therapy of prostate cancer
Worldwide, an estimated 1,095,000 men are diagnosed with and 307,000 men die from prostate cancer each year and with increasing life expectancy, the incidence is increasing. Still, developments in diagnosis and treatment of prostate cancer are evolving rapidly. A number of imaging methods to study prostate cancer have been suggested, including methods which have been available for decades, e.g. Computed Tomography (CT), Bone Scintigraphy (BS), and Trans Rectal Ultrasound (TRU), as well as methods which were introduced more recently, e.g. whole-body magnetic resonance imaging (MRI), multiparametric (mp) MRI, and Positron Emission Tomography (PET). Several PET radiotracers have been suggested for imaging prostate cancer, and in recent years ligands for PSMA (Prostate Specific Membrane Antigen) have gained an increasing success. PSMA PET has been introduced in 2013 and since then it has emerged as the most promising imaging method, allowing to study contemporary the primary tumor, as well as the nodal lesions and the metastases. In particular, PSMA PET is largely used for evaluating recurrent PC after radical therapy, and is now incorporated into clinical guidelines. Furthermore, the availability of therapeutic radiopharmaceuticals (such as Lu-PSMA) could led in the future at treating the metastatic PC using the same target. With PSMA PET, again, nuclear medicine innovations are at the forefront of fighting cancer, while keeping patient safety in the center of attention.
ESMIT: raising the quality of the professionals attending to cancer patients
Education is one of fundamental activities of the European Association of Nuclear Medicine (EANM). Apart from the many opportunities of medical education related to the yearly congress organized by the EANM, and various other events, the EANM has launched a dedicated school activity, known as European School of Multimodality Imaging & Therapy (ESMIT). The ESMIT initiative represents EANM’s response to huge changes in the educational needs of the nuclear medicine community and the rising demand for greater multimodality content. The EANM decided to review and modernize its educational system, since the community needs not only to be educated on all modalities that are used in imaging, but also to be well prepared in the therapeutic applications of our discipline. Since 2016 ESMIT is organizing teaching events all around Europe, covering different aspects of nuclear medicine’s contribution in the field of oncology, focusing on delivering quality cancer care for the benefit of our patients.
Theranostics: the perfect coupling of imaging and treating
Nuclear Medicine has unique characteristics that may play a fundamental role for the proper management of cancer patients. The use of radiopharmaceuticals that target a specific function allow to visualize the tumor and contemporary to demonstrate the rationale for curing the cancer using that same target. This could be done using PET emitters for imaging and therapeutic isotopes. A perfect example are NeuroEndocrine tumors, which are known to overexpress Somatostatin Receptors (SSR). Using a ligand specifically targeted to bind at SSR it is possible to visualize at PET the neoplastic lesions, for example with Ga-DOTA-NOC, and demonstrate in vivo the expression of SSR. Then, using a therapeutic agent binding to same ligand, such as Lu-DOTA-TATE, it is possible to treat the cancer. The multidisciplinary, integrative nature of nuclear medicine procedures, involving referring physicians, medical doctors, scientists, technologists and nurses ensure that quality cancer care is delivered throughout the patient journey.