Current Status of Theranostics in Jordan

Akram Al-Ibraheem,Ali Mohamedkhair 대한핵의학회 2019 핵의학 분자영상 Vol.53 No.1

Exploring the unknown is one of the key factors that lead to great discoveries in mankind history.With the advances in medicine and the development of new approaches towards patient care, like next-generation sequencing and patient-centered care, the need for treatments tailored to patient through personalized medicine has become more compelling. Theranostics has been introduced as a combination of a diagnostic tool and a therapeutic tool on the same vector for a specific disease, to facilitate personalized medicine. Nuclear medicine has shown the capability of providing a strong platform for this new approach through its arms, molecular imaging, and targeted molecular therapies. Though the prototype of theranostics has been practiced in Jordan since decades in the field of diagnosis and treatment of well-differentiated thyroid cancer, recently, the King Hussein Cancer Center (KHCC), a leading and comprehensive cancer center in Jordan and in the Middle East, has leaped forward to introduce the new approaches of theranostics through the nuclear medicine applications. This paper sheds the light on the most important aspects of this new theranostics practice in Jordan such as peptide receptor radionuclide therapy (PRRT) and prostate-specific membrane antigen (PSMA)–based theranostics.

68Ga-DOTATOC Embolus Manifestation and Spontaneous Resolution by PET/CT

Akram Al-Ibraheem,Deya’ Aldeen Sweedat,Anwer Farah,Feras Istatieh,Malik E. Juweid 대한핵의학회 2022 핵의학 분자영상 Vol.56 No.4

68Ga-labeled somatostatin receptor analogs physiologic distribution patterns have become recognizable among nuclear medicine physicians because of the increasing routine clinical use of this modality in the work-up of neuroendocrine tumors. Some pitfalls during 68Ga-labeled somatostatin receptor PET/CT have recently been reported as causes of misdiagnoses. Iatrogenic microembolism as a cause of 18F-FDG embolus is well-established; however, 68Ga-DOTATOC embolus is not well documented in the literature. In the current case, the presence and the spontaneous resolution of the 68Ga-labeled somatostatin receptor analogs embolus during sequential PET/CT are nicely demonstrated. Awareness of this incidental finding would avoid misdiagnosis and unnecessary investigations.

161Tb‑PSMA Unleashed: a Promising New Player in the Theranostics of Prostate Cancer

Akram Al-Ibraheem,Andrew M. Scott 대한핵의학회 2023 핵의학 분자영상 Vol.57 No.4

Radiotheranostics with 177Lu-PSMA have changed the treatment paradigm in patients with prostate cancer, becoming thenew standard in certain settings. Terbium-161 (161Tb) has been recently investigated as a potential radionuclide for radiotheranosticsin various types of cancer, including metastatic castration-resistant prostate cancer (mCRPC). The nuclearmedicine team at King Hussein Cancer Center (KHCC) in Amman, Jordan, recently published the first-in-human SPECT/CT imaging results following a well-tolerated dose of 161Tb-PSMA radioligand therapy with no treatment-related adverseevents, adding to the potential of radiotheranostics in prostate cancer. Two clinical trials for 161Tb-PSMA radioligand therapyin prostate cancer are currently underway and will provide valuable insights. This review will shed light on the expandingfield of radiotheranostics in prostate cancer, which is not without challenges, and will discuss how the introduction of a newtherapeutic option like 161Tb-PSMA may help to combat these challenges and build on the proven success of 177Lu-PSMAbasedradiotheranostics for the benefit of prostate cancer patients worldwide.

Synchronous Colorectal and Prostate Cancer: Dual PET/CT Approach for Detecting and Distinguishing Metastatic Patterns

Akram Al‑Ibraheem 대한핵의학회 2023 핵의학 분자영상 Vol.57 No.6

Prostate cancer (PC) and colorectal cancer (CRC) are two of the leading causes of cancer-related mortality. The incidence ofsynchronous neoplasms in patients with CRC is increasing, though synchronous PC and CRC remains a rare occurrence inclinical practice. Early diagnosis, accurate staging, and characterization of tumors are essential for selecting patient-tailoredtherapy. The origin of metastatic disease in synchronous cases presents a challenge for conventional imaging modalities, butadvances in molecular imaging have addressed this limitation. Positron emission tomography/computed tomography (PET/CT) is now the preferred modality for assessing synchronous cases. The authors present a 72-year-old male patient with therare occurrence of two coexisting primary cancers. At first, fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT detected thefirst colorectal primary tumor extension along with evidence of heterogeneous 18F-FDG activity within an enlarged prostate,warranting further evaluation. Subsequently, gallium-68 prostate-specific membrane antigen (68 Ga-PSMA) PET/CT imagingrevealed the second prostate primary cancer with evidence of bone metastases. Adoption of a dual PET/CT approach incases where biopsy is impractical can achieve accurate staging results during the initial diagnostic workup.

Molecular Imaging in Recurrent Prostate Cancer Presented as a Mixed Small Neuroendocrine Tumor/Acinar Adenocarcinoma

Akram Al-Ibraheem,Dhuha Ali Al‑Adhami,Ahmed Saad Abdlkadir,Nabeela Al‑Hajaj,Rami Ghanem,Ramiz Abu‑Hijlih,Samer Salah 대한핵의학회 2023 핵의학 분자영상 Vol.57 No.4

Molecular imaging is an important tool for evaluating patients with prostate cancer, including those with hybrid histopathology. Although rare, mixed small neuroendocrine tumor/acinar adenocarcinoma exhibit aggressive behavior that necessitatesoptimal therapy. Molecular imaging has been implemented previously to assess radioligand therapy eligibility in such cases. Interestingly, the uptake of radiotracers targeting prostate-specific membrane antigen (PSMA) and somatostatin receptor maybe reduced and can potentially lead to false negative readings in certain tumor types with hybrid features. Therefore, physiciansshould be aware of different kinds of disparities when assessing these tumor types with the aforementioned modalities.

Peptide Receptor Radionuclide Therapy and the Treatment of Gastroentero-pancreatic Neuroendocrine Tumors: Current Findings and Future Perspectives

Hirmas, Nader,Jadaan, Raya,Al-Ibraheem, Akram 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.3

Purpose and Methods Patients with inoperable and metastasized neuroendocrine tumors (NETs), particularly those with grades 1 and 2, usually receive treatment with somatostatin analogues (SSAs). Peptide receptor radionuclide therapy (PRRT) has gained momentum over the past two decades in patients who progress on SSAs. 177Lu-DOTATATE is currently the most widely used radiopeptide for PRRT. We reviewed the recent evidence on PRRT and the treatment of gastroentero-pancreatic neuroendocrine tumors (GEP-NETs). Results $^{177}Lu$-DOTATATE can be used as neoadjuvant treatment in patients with inoperable GEP-NETs, who might be candidate for surgery after treatment and as adjuvant therapy after surgical intervention. Combination treatments of PRRT with chemotherapy or targeted agents as well as combinations of radionuclides in patients with NETs have been explored over the last few years. The majority of patients with NETs experience partial response or have disease stabilization, a small percentage has complete response, while some 30% of patients, however, will have disease progression. The safety and efficacy of retreatment with extra cycles of PRRT as salvage therapy have been evaluated in small retrospective series. Conclusion Overall, there is evidence that disease control and quality of life improve significantly after 117Lu PRRT therapy. Clinical trials on this therapy are scarce, and there is a need for further studies to establish proper management guidelines.

68Ga DOTA-TOC Uptake in Non-ossifying Fibroma: a Case Report

Khalaf Aysar,Hirmas Nader,Anwer Farah,Akram Al-Ibraheem 대한핵의학회 2020 핵의학 분자영상 Vol.54 No.4

Non-ossifying fibroma (NOF) is a common benign bone tumor with a high probability of occurrence in children and adolescents. It is commonly seen in the metaphysis of long bones, eccentrically located, and can coexist with other malignant tumors such as neuroendocrine tumors (NET). To date, plain radiographs play a major role in the diagnosis of these benign bone tumors. Herein, we report the case of a 13-year-old male patient who was diagnosed with pulmonary NET and underwent right lung lobectomy for a hilar mass which later revealed a well-differentiated NET. The follow-up 68Ga DOTA-TOC PET/CT showed a focal somatostatin receptor expression in the left distal femur, with corresponding CT component findings of a well-defined osteolytic bone lesion located within the medial aspect of the left distal femoral metaphysis, strongly indicative of NOF. To the best of our knowledge, this is the first reported case of such an occurrence.