Molecular imaging and radionuclide therapy of pheochromocytoma and paraganglioma in the era of genomic characterization of disease subgroups.

摘要: In recent years, advancement in genetics has profoundly helped to gain a more comprehensive molecular, pathogenic, and prognostic picture of pheochromocytomas paragangliomas (PPGLs). Newly discovered molecular targets, particularly those that target cell membranes or signaling pathways have move nuclear medicine the forefront PPGL precision medicine. This is mainly based on introduction increasing experience various PET radiopharmaceuticals across genotypes quickly followed by implementation novel radiotherapies revised imaging algorithms. Particularly, 68Ga-labeled-SSAs shown excellent results diagnosis staging PPGLs selecting patients for PRRT as potential alternative 123/131I-MIBG theranostics. using 90Y/177Lu-DOTA-SSAs promise treatment with improvement clinical symptoms and/or disease control. However, well-designed prospective studies are required confirm these findings, order fully exploit PRRT's antitumoral properties obtain final FDA approval. Such an approval recently been obtained high-specific-activity 131I-MIBG inoperable/metastatic PPGL. The encouraging preliminary radiotherapeutic approaches now raises important question how further integrate them into management (e.g. monotherapy combination other systemic therapies), carefully taking account locations, genotypes, growth rate. Thus, targeted radionuclide therapy (TRT) should preferably be performed at specialized centers experienced interdisciplinary team. Future perspectives include dosimetry biomarkers therapeutic responses individualized plans, α-emitting isotopes, TRT therapies.