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Objective: This study aimed to compare 18 FDGPET/CT in patients who develop bone metastases due to various cancers and to investigate the prognostic significance of the 68 FAPI-PET/CT SUVmax value for survival., Methods: Patients with bone metastases who underwent both 68  Ga-FAPI PET/CT and  18 FDGPET/CT within a 1 week period were included in this retrospective study. The effect of the SUVmax value of bone lesions on overall survival was analyzed., Results: A total of 75 eligible patients with 139 bone lesions were included in this study. The median age of the patients was 55 (30-83) and 48(64%) patients were newly diagnosed. The primary lesion median 68  Ga-FAPI PET/CT SUVmax value was higher than the median 18 FDGPET/CT SUVmax (10.75 versus 6.7). Bone lesions 68  Ga-FAPI PET/CT SUVmax median (IQR) were 7.8 (4.6-13.2), and 18 FDGPET/CT SUVmax of bone lesions were 5.9 (3.8-8.2). More bone lesions were detected on 68  Ga-FAPI PET/CT than on 18 FDGPET/CT(median IQR 4 [1-9] versus 2 [1-6] (p = 0.014). The extra lesions observed on 68  Ga-FAPI PET/CT were mostly sclerotic bone lesions (p = 0.001). 68  Ga-FAPI PET/CT SUVmax was significantly higher in vertebra and thorax lesions (p = 0.011 and p = 0.018, respectively). While the bone lesion 68  Ga-FAPI PET/CT SUVmax affected the OS, the 18 FDGPET/CT SUVmax value did not affect the OS (p < 0.001 and p = 0.079, respectively). In ROC analysis, a cut-off-off value of 68  Ga-FAPI PET/CT SUVmax > 7.7 was found for OS (AUC: 0.619). The median OS in the group above the cut-off value was worse than that in the group below the cut-off value (32 versus 45) months (p = 0.002). In the multivariate analysis for OS, the 68  Ga-FAPI PET/CT SUVmax of bone lesions was an important parameter, as well as cancer subtype, ALP level, and disease occurrence., Conclusions: 68  Ga-FAPI PET/CT detected more bone lesions and higher SUVmax values than 18 FDGPET/CT in various cancers. The prognostic value of the SUVmax value of 68  Ga-FAPI PET/CT bone lesions was observed regardless of disease subtype., (© 2024. The Author(s), under exclusive licence to The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.)

Accurate staging of invasive lobular carcinoma (ILC), a subtype of breast cancer, is vital for effective clinical management. Although 18 F-FDG PET/CT is a commonly used tool, its efficacy varies across different histologic subtypes. To mitigate this challenge, our investigation delves into the potential utility of 68 Ga-fibroblast activation protein inhibitor (FAPI) PET/CT as an alternative for staging ILC, aiming to address a significant research gap using a more expansive patient cohort than the smaller samples commonly found in the existing literature. Methods: In this retrospective analysis, women diagnosed with primary ILC of the breast underwent both 18 F-FDG PET/CT and 68 Ga-FAPI PET/CT. Both modalities were compared across all lesion locations with the used reference standard. The interval between scans was 1 wk, without any intervening treatments. Lesions were categorized visually, and tracer activity was analyzed using SUV max , tumor-to-background uptake ratio, and uptake ratios. Both modalities were compared across various parameters, and statistical analysis was performed using SPSS 22.0. A P value of less than 0.05 was chosen to determine statistical significance. Results: The study included 23 female ILC patients (mean age, 51 y) with hormone-positive, human epidermal growth factor receptor type 2-negative tumors. Most (65%) had the luminal A subtype. 68 Ga-FAPI PET/CT outperformed 18 F-FDG PET/CT, with higher tumoral activity and tumor-to-background uptake ratios ( P < 0.001). Primary tumors showed significantly increased uptake with 68 Ga-FAPI PET/CT ( P < 0.001), detecting additional foci, including multicentric cancer. Axillary lymph node metastases were more frequent and had higher uptake values with 68 Ga-FAPI PET/CT ( P = 0.012). Moreover, 68 Ga-FAPI PET/CT identified more lesions, including bone and liver metastases. Pathologic features did not significantly correlate with imaging modalities, but a positive correlation was observed between peritumoral lymphocyte ratio and 68 Ga-FAPI PET/CT-to- 18 F-FDG PET/CT uptake ratios ( P = 0.026). Conclusion: This study underscores 68 Ga-FAPI PET/CT's superiority over 18 F-FDG PET/CT for ILC. 68 Ga-FAPI PET/CT excels in detecting primary breast masses, axillary lymph nodes, and distant metastases; can complement 18 F-FDG PET/CT in ILC; and holds potential as an alternative imaging method in future studies., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Objective: This study aimed to evaluate the therapeutic efficacy and safety of 177 Lutetium-Prostate Specific Membrane Antigen ( 177 Lu-PSMA-617) radioligand treatment (RLT) in metastatic castration-resistant prostate cancer (mCRPC) patients with aged older than 75 years., Methods: A total of 37 patients with mCRPC aged older than 75 years treated with 177 Lu- PSMA-617 were included in this study. Pre-therapy and post-therapy biochemical, metabolic, and clinical response results and Hb, TLC, platelet, serum creatinine and bilirubin levels were checked to evaluate the therapeutic efficacy and toxicity profile. The Common Terminology Criteria for Adverse Events was used for grading adverse events caused by 177 Lu-PSMA-617 treatment., Results: The mean age of the patients included in the study was 79.8±2.9 (76-92). The number of 177 Lu-PSMA-617 treatment cycles ranged from two to four, and the mean administered radioactivity dose was 5.6±0.8 GBq per cycle. Partial biochemical response (PR) and partial metabolic response (PMR) were observed in 11 (29.7%) and 15 (40.6%) patients after treatment, respectively. Although improvement in ECOG scores was observed in 5 (13.5%) patients after treatment, it was not statistically significant. Grade 2 and 3 Hb toxicity was observed in 10 (27%) and 2 (5.4%) patients, respectively. Grade 2 leukocytopenia in six patients, Grade 1 thrombocytopenia in six patients, and Grade 2 serum creatinine toxicity in five patients were seen after the treatment. On the other hand, no patients developed liver toxicity and grade 3 or 4 leukocytopenia, thrombocytopenia or creatinine toxicity., Conclusion: 177 Lu-PSMA-617 treatment was a safe and effective treatment option for properly selected elderly mCRPC patients., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: We aimed to evaluate the efficacy oflutetium-177-prostate-specific membrane antigen-617 ( 177 Lu-PSMA-617) with the luteinizing hormone releasing hormone (LHRH) analogues in the first or in the second-line setting formetastatic castration sensitive patients and metastatic castration resistance after progression with LHRH analogues., Subjects and Methods: Sixteen consecutive patients with high volume metastatic prostate cancer undergone 177 Lu-PSMA-617 therapy who were refused chemotherapy and were unable to use new generation anti-androgen drugs because of unavailibility of reimbursement, were included in this retrospective study. Prostate specific antigen (PSA) response (>50% decrease), disease control rate (DCR: complete or partial response), progression-free survival (PFS) and overall survival (OS) were calculated to evaluate according to the clinicopathological features of the patients. Treatment response evaluated by 68 Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT)., Results: Mean age was 74,6 (SD±8,36). Among them, 7 (43,8%) patients has castration resistant disease, while the remaining has castration sensitive disease. Lutetium-177-PSMA-617 was administered to 10 (62,5%) patients as one of the first-line treatment and 6 patients received the treatment after progression on LHRH as a second-line treatment. Considering all patients, PSA response rate and DCR were 50% and 62% respectively. The median PFS and OS (with 95% CI) were 11,2 months (11-15) and 29 months (25,6-32,4), respectively in patients treated with 177 Lu-PSMA-617 and LHRH analogues. Clinicopathological features and basal PSA level did not have effect on PSA response rates, DCR, OS and PFS. On the other hand, increment in PFS and OS (with 95% CI) was observed in castration resistant disease and in the second-line therapy; for castration resistant disease 16,5 months (12.3-19.7); 30 months (25.3-32.7), for the second-line therapy 14.5 months (12-20.5); 29 months (NR), respectively but statistically not significant. Serious toxicity was observed in a limited number of patients (18,7%), treatment-related death was not observed., Conclusion: Favorable results can be achived with second-line 177 Lu-PSMA-617 treatment in terms of OS and PFS, especially in castration-resistant disease, when chemotherapy and new generation ADT's cannot be used.

Introduction: Radioligand therapy which targets the prostate specific membrane antigen (PSMA) has recently considered as option in the treatment of metastatic castration resistant prostate cancer (mCRPC). The aim of this study was to evaluate the biochemical, clinical and radiological data of patients received treatment with 177 Lu-PSMA-617 RLT in our clinic following the diagnosis of mCRPC, and to investigate the relationship between treatment timing and metastasis region and survival., Material and Methods: This is a retrospective, observational, single-center study from December 2016 to December 2019. Patients underwent 177 Lu-PSMA-617 RLT with a diagnosis of mCRPC. We used the Kaplan-Meier test and the Cox regression proportional hazard test to assess survival data., Results: 95 patients with an average age of 70.45 (50-85) were evaluated retrospectively. Median follow-up was 10.86 months (8.15-11.94 months) and the median lines of 177 Lu-PSMA-617 RLT treatment was 4 (1-5). Median overall survival was found to be 17.03 ± 5,78 months in the patients receiving the treatment at the third or lower lines while it was 10,30 ± 0,93 months in patients receiving the treatment at the fourth or higher lines (p = 0.021). When evaluating patients with only bone metastasis and patients with bone and lymph node metastasis, the median overall survival was 11.46 ± 0.87 months and 12.13 ± 3.02 months (p = 0.445), respectively., Conclusion: 177 Lu-PSMA-617 RLT treatment provides better survival in the treatment of patients diagnosed with mCRPC after standard treatments and received it earlier. 177 Lu-PSMA-617 RLT treatment could be an effective treatment method in mCRPC patients with bone and lymph node metastasis., (Copyright © 2021. Published by Elsevier España, S.L.U.)

Objective: We aimed to evaluate the gallium-68-labeled fibroblast-activation protein inhibitor ( 68 Ga-FAPI) positron emission tomography/computed tomography (PET/CT) in localizing papillary thyroid carcinoma (PTC) foci in patients with biochemical relapse. Papillary thyroid carcinoma has achieved biochemical recovery after appropriate treatment and had biochemical relapse in the last follow-up were included in this retrospective study. Gallium-68-FAPI and fluorine-18-fluorodeoxyglucose ( 68 F-FDG) PET/CT were performed to detect recurrence foci., Subjects and Methods: Biochemically relapsed patients who underwent total thyroidectomy and were diagnosed with pathologically differentiated thyroid cancer were included in our study. Gallium-68-FAPI and 18 F-FDG PET/CT imaging methods were used to determine the focus of metastasis or recurrence in all patients., Results: Among 29 patients enrolled to the study, pathological subgroups were papillary (n=26) and poorly differentiated (n=3) PTC. Anti-thyroglobulin (TG) antibody positivity were noted in 5 of the patients, while all 29 of them were TG positive and had been consist of three groups as follows: 2-10ng/mL (n=4), 11-300ng/mL (n=14), 301ng/mL and above (n=11). Recurrence was detected in 72.4% (n=21) and 86% (n=25) of the patients via 18 F-FDG and 68 Ga-FAPI, respectively. Accuracy of detection noted as 100% (5/5), 75% (3/4), and 92.9% (13/14) in groups with the anti-TG antibody positivity, TG levels of 2-10ng/mL and 11-300ng/mL, respectively, when the two imaging modalities were utilized together. Furthermore, accuracy of 68 Ga-FAPI was 100% (11/11) in the group with TG levels of 301ng/mL and above, whereas accuracy of 18 F-FDG was 81.8% (9/11). Lastly, median maximum standardized uptake value (SUVmax) of recurrent lesions detected by the 68 Ga-FAPI (median SUVmax: 6.0) were statistically higher than the ones detected by the 18 F-FDG (median SUVmax: 3.7) (P=0.002)., Conclusion: In recurrent PTC especially in case of higher TG levels, 68 Ga-FAPI can be used in patients with inconclusive 18 F-FDG findings.

Purpose: In this study, we aimed to investigate the utilization of 68 Ga-FAPI PET/CT in comparison to 18 FDG PET/CT to evaluate the peritoneal involvement of the gastrointestinal malignancies alongside primary lesions and other metastatic foci., Procedures: A total of 37 patients with various gastrointestinal malignancies with accompanying peritoneal involvement who underwent 68 Ga-FAPI PET/CT and 18 FDG PET/CT imaging between September 2020 and June 2021 were included in this retrospective study. SUV max values of 68 Ga-FAPI and 18 FDG were compared according to lesion locations. Also, the lesion localization ability of both imaging was compared in patient basis., Results: Of the 37 patients with peritoneal involvement (23 males and 14 females; median age, 62.8 ± 12.7 years), 35.1% (n = 13) had colorectal cancer, 37.8% (n = 14) gastric cancer, and 27.0% (n = 10) pancreaticobiliary cancer. While 45.9% of them were operated, the remaining did not have surgery. The mean time interval between two studies was 3.2 days (range: 2-6 days). The mean SUV max value of peritoneal metastases (p < 0.001) was significantly higher with 68 Ga-FAPI PET/CT compared to that with 18 FDG PET/CT, as in primary lesions (p < 0.001), lymph node metastases (p = 0.006), liver metastases (p = 0.002), and bone metastases (p = 0.018). A total of 185 lesions was detected in the initial assessment with 18 FDG PET/CT. Of the total lesions detected with 18 FDG PET/CT, 5 of them were evaluated as benign lesions with 68 Ga-FAPI PET/CT also in accordance with the reference standard. In addition to 180 lesions detected with 18 FDG PET/CT, a total of 37 additional malignant lesions, 12 of which were peritoneal metastases, were detected with 68 Ga-FAPI PET/CT., Conclusion: 68 Ga-FAPI PET/CT was determined to be superior to 18 FDG PET/CT in terms of detection of peritoneal involvement with high image quality as well as primary tumor and other metastatic foci. Consequently, 68 Ga-FAPI PET/CT can be used as a complementary imaging modality especially for inconclusive 18 FDG findings due to the lack of accuracy of 18 FDG PET/CT in some of the metastatic regions, especially in the liver., (© 2022. World Molecular Imaging Society.)

Objective: In this study, we aimed to compare [68Ga]FAPI PET/CT and [18F]FDG PET/CT imaging to detect lesions in multiple myeloma., Methods: A total of 14 patients with multiple myeloma who underwent [68Ga]FAPI PET/CT and [18F]FDG PET/CT imaging were included in this retrospective study. SUV max values of [68Ga]FAPI and [18F]FDG were compared according to lesion locations. Also, lesion localization ability of both imaging methods was compared on the patient basis., Results: In 4 of 14 patients, [68Ga]FAPI PET/CT and [18F]FDG PET/CT have not detected any bone lesions. In 8 of the remaining 10 patients [18F]FDG PET/CT detected bone lesions but in this group, 6 patients showed more higher SUV max values than [18F]FDG PET/CT in [68Ga]FAPI PET/CT.In contrast, 2 of 8 patients showed more higher SUV max values than [68Ga]FAPI PET/CT in [18F]FDG PET/CT. Moreover, [68Ga]FAPI PET/CT detected bone lesions in two patients, which werenot detected by [18F]FDG PET/CT. Also, in five patients, [68Ga]FAPI PET/CT showed more bone lesions in comparison with[18F]FDG PET/CT. Only one patient, [18F]FDG PET/CT showed more bone lesions. Three extramedullary involvements were observed in the following locations: lung, presacral lymph node, and soft tissue mass lateral to the right maxillary sinus. Among these involvements, higher SUV max values were observed in the lung and presacral lymph node with [68Ga]FAPI compared to [18F]FDG. However, the soft tissue mass showed a higher SUV max value in [18F]FDG than [68Ga]FAPI., Conclusions: No significant superiority was observed in [68Ga]FAPI PET/CT over [18F]FDG PET/CT in patients with MM. However, [68Ga]FAPI PET/CT can be utilized as a complementary imaging method to [18F]FDG PET/CT in some settings, especially in low-[18F]FDG affinity and inconclusive cases. Considering the favorable aspects of [68Ga]FAPI PET/CT in MM, such as low background activity, absence of non-specific bone marrow, and physiological brain involvement, further studies with a larger sample size should be conducted.

Purpose: We compared the ability of 68 Ga-FAPI PET//CT with 18 FDG PET/CT imaging techniques to detect additional lesions in breast cancer patients that may affect further chemotherapy options., Methods: A total of 48 patients with breast cancer underwent concurrent 68 Ga-FAPI-04 and 18 FDG PET/CT regardless of whether they had received chemotherapy or not in the last month before imaging. Both modalities were compared according to various parameters: clinical/pathological features, number of lesions detected, activity uptake (SUV max ), and the effect on the evaluation of response to treatment in the post-chemotherapy group., Results: This retrospective study included 48 patients with breast cancer (mean age 53.3 ± 11.7 years; IDC 89.6%; ILC 10.4%). In the comparison of both modalities, no statistical significance was obtained in terms of the pathological characteristics of the patients. More lesions were demonstrated in all categorized regions in 68 Ga-FAPI PET/CT imaging with higher uptake values compared to 18 FDG PET/CT in this study. In the treatment response evaluation of the post-chemotherapy group, 12 cases (12/24) who were evaluated as PMR, CMR, or SD according to 18 FDG PET/CT results were later accepted as PD due to newly detected lesions in complementary 68 Ga-FAPI PET/CT imaging and treatment of patients was managed accordingly by clinicians., Conclusion: It was determined that 68 Ga-FAPI PET/CT was superior to 18 FDG PET/CT in terms of accuracy and it was thought that 68 Ga-FAPI PET/CT could be utilized as an additional complementary imaging to 18 FDG PET/CT. Moreover, 68 Ga-FAPI PET/CT, with its significant theranostic potential, could become a key element in predicting the pathological response of breast cancer patients in further researches., (© 2021. The Japanese Society of Nuclear Medicine.)

High-fat diet (HFD) consumption leads to metabolic disorders, gastrointestinal dysfunction and intestinal dysbiosis. Antibiotics also disrupt the composition of intestinal microbiota. The aim of the present study was to investigate the impact of a short-term feeding with HFD on oxidative status, enteric microbiota, intestinal motility and the effects of antibiotics and/or melatonin treatments on diet-induced hepato-intestinal dysfunction and inflammation. Male Sprague-Dawley rats were pair-fed with either standard chow or HFD (45 % fat) and were given tap water or melatonin (4 mg/kg per d) or melatonin plus antibiotics (ABX; neomycin, ampicillin, metronidazole; each 1 g/l) in drinking water for 2 weeks. On the 14th day, colonic motility was measured and the next day intestinal transit was assessed using charcoal propagation. Trunk blood, liver and intestine samples were removed for biochemical and histopathological evaluations, and faeces were collected for microbiota analysis. A 2-week HFD feeding increased blood glucose level and perirenal fat weight, induced low-level hepatic and intestinal inflammation, delayed intestinal transit, led to deterioration of epithelial tight junctions and overgrowth of colonic bacteria. Melatonin intake in HFD-fed rats reduced ileal inflammation, colonic motility and perirenal fat accumulation. ABX abolished increases in fat accumulation and blood glucose, reduced ileal oxidative damage, suppressed HFD-induced overgrowth in colonic bacteria, and reversed HFD-induced delay in intestinal transit; however, hepatic neutrophil accumulation, hepatic injury and dysfunction were further enhanced. In conclusion, the results demonstrate that even a short-term HFD ingestion results in hepato-intestinal inflammatory state and alterations in bacterial populations, which may be worsened with antibiotic intake, but alleviated by melatonin.