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Whole-body tumor burden in PET/CT expert review

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Abstract

Introduction

PET/CT whole-body tumor burden (WBTB), as a measure for overall burden of cancer, has been shown bear a strong correlation with prognosis. In the last decade, there has been significant progress in WBTB determination because of software advances and the increasing availability of positron-emitting radiopharmaceuticals. However, the determination of tumor burden with PET/CT is still a challenge especially in widespread metastatic disease.

Methods

In this non-systematic review, we will discuss the current role of determination of WBTB in cancer such as non-small cell lung cancer, lymphoma, breast cancer, among others and with a variety of radiotracers. Furthermore, we will address imaging techniques and quantification methods available and challenges.

Results

Many types of segmentation methods and different thresholds according to tumor types and radiotracers can be applied. These variations may show different WBTB results, but in general, despite variations, WBTB determination for staging purposes in lung cancer, breast cancer, lymphoma, melanoma, prostate cancer and neuroendocrine tumors have shown to bear a strong correlation with patient prognosis.

Conclusion

PET/CT whole-body tumor burden has an invaluable potential to assess prognosis. The accelerated radiopharmaceutical development will provide molecules and mechanisms to determine WBTB with advanced imaging qualification tools to further adjust radiotherapeutic doses in oncology. WBTB will most likely only become routinely accessible in clinical practice when fully automated programs become available and standardized.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Campinas State University (UNICAMP), Rua Vital Brasil, 251, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-888, Brazil

    Dihego F. Santos, Mariana da Cunha Lopes de Lima, Bárbara Juarez Amorim & Elba Etchebehere

  2. Gleb Wataghin Physics Institute, University of Campinas (UNICAMP), Campinas, Brazil

    Maria Emilia Takahashi

  3. Medicina Nuclear de Campinas (grupoMND), Campinas, Brazil

    Mariana Camacho & Mariana da Cunha Lopes de Lima

  4. Baylor College of Medicine, Houston, TX, USA

    Eric M. Rohren & Elba Etchebehere

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DFS: literature review and writing. MET: literature review and writing. MC: writing and editing. MCLL: writing and editing. BJA: writing and editing. EMR: writing and editing. EE: content planning, editing and writing.

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Santos, D.F., Takahashi, M.E., Camacho, M. et al. Whole-body tumor burden in PET/CT expert review. Clin Transl Imaging 11, 5–22 (2023). https://doi.org/10.1007/s40336-022-00517-5

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