^(68)Gallium-labelled PSMA-PET/CT as a diagnostic and clinical decision-making tool in Asian prostate cancer patients following prostatectomy

Objective: Prostate cancers(PCa) in Asian individuals are molecularly distinct from those found in their Caucasian counterparts.There is no risk stratification tool for Asian men with rapid biochemical recurrence(BCR) following radical prostatectomy(Rad P). This study aims to assess the detection rate of ^(68)Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography(PSMA-PET/CT) for diagnosis of clinical recurrence and as a treatment decision making tool in Asian patients with BCR post-Rad P.Methods: ^(68)Ga PSMA-PET and CT body with/without bone scan [conventional workup(CWU)] were performed in 55 Asian patients with BCR within 36 months post-Rad P. Two blinded reviewers assessed the images. Detection rates of ^(68)Ga PSMAPET/CT were evaluated, and impact on management was reviewed by comparison with CWU.Results: Median time to BCR post-Rad P was 8.1 months. Detection rate for ^(68)Ga PSMA-PET/CT was 80%(44/55). A positive scan was significantly associated with increasing prostate-specific antigen(PSA) level [odds ratio(OR) = 1.13(95% CI 1.05–1.30), P =0.017], but not with higher Gleason grade or shorter PSA doubling time. Compared to CWU, ^(68)Ga PSMA-PET/CT detected an additional 106 lesions in 33/44 patients with a positive scan, resulting in a change in management in 25/44(56.8%) patients: 10 to hormonal therapy(HT) and whole pelvis radiotherapy(RT) in addition to bed RT, and 15 to palliative HT alone.Conclusions: In the present report, we demonstrated the diagnostic and treatment decision utility of ^(68)Ga PSMA-PET/CT in Asian men with rapid BCR. Detection of small volume nodal and systemic recurrences at low PSA levels(< 1.0 ng/mL) highlights the role of the tool in assigning patients to treatment intensification with HT-RT or palliative HT in polymetastatic disease.

Surgery as an alternative to radiotherapy in early-stage nasopharyngeal carcinoma:innovation at the expense of uncertainty

Radiotherapy(RT)has an unassailable track record as the backbone of treatment in nasopharyngeal carcinoma(NPC).Several reasons explain its dominance.Likewise to human papilloma virus-associated oropharyngeal squamous cell carcinoma,Epstein-Barr virus(EBV)-associated NPC is exquisitely sensitive to RT.Thus,huge leaps with technological advances in RT delivery over the past decades have led to substantial improvements in tumor control,while reducing debilitating late RT-induced complications[1,2].Innovations in this space continue to drive the enhancement of the therapeutic ratio of RT,with the goal of enhancing the quality of life(QoL)among long-term survivors[3].Therefore,there has not been any compelling reason to disrupt this timehonored convention of employing RT as the standard of care in NPC.

JUPITER-02 trial: advancing survival for recurrent metastatic nasopharyngeal carcinoma and next steps

Nasopharyngeal carcinoma(NPC)is a disease with unique epidemiology.It is endemic in Southern China,Southeast Asia,and North Africa,and typically affects males more than females in the 30-60 years age group[1].Globally,133,354 NPC cases were diagnosed in 2020 with 80,008;deaths in the same year[2].While the survival rates of early-stage NPC after radiotherapy(RT)are high,dis-ease recurrences are common in locoregionally-advanced NPC,with the predominant pattern of failure being dis-tant metastasis[3].In this clinical scenario,palliative chemotherapy is the primary treatment modality。

Retreatment in locally recurrent nasopharyngeal carcinoma:Current status and perspectives

1 Background Nasopharyngeal carcinoma(NPC)arises from the epithelial cells that cover and line the nasopharynx.While it is considered a rare cancer globally,it is commonly observed in South China and a few other ethnically distinct racial groups.Due to its propensity to spread early through the submucosal tissue and the highly infiltrative nature of this disease,NPC spreads easily through areas of lesser resistance within the pharyngobasilar fascia with a tendency for neural infiltration[1-3].