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Theranostics in Nuclear Medicine: Historical, Regulatory, and Evidence Context for the Practicing Nuclear Medicine Physician. 核医学治疗学：实践核医学医师的历史、法规和证据背景。
PET clinics Pub Date : 2026-05-06 DOI: 10.1016/j.cpet.2026.02.006
Deepak Behera, Alexander McEwan
{"title":"Theranostics in Nuclear Medicine: Historical, Regulatory, and Evidence Context for the Practicing Nuclear Medicine Physician.","authors":"Deepak Behera, Alexander McEwan","doi":"10.1016/j.cpet.2026.02.006","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.02.006","url":null,"abstract":"<p><p>Theranostic radiopharmaceutical therapy has moved from niche practice to mainstream oncology, anchored by approvals of lutetium Lu 177 dotatate for somatostatin receptor-positive neuroendocrine tumors and lutetium Lu 177 vipivotide tetraxetan for PSMA-positive prostate cancer. Yet the field's future depends on rigorous clinical trial design, realistic operational planning, and workforce readiness. This review summarizes how theranostics evolved, outlines current regulatory and trial-design yardsticks (including dose optimization and expectations for assessment of late-toxicity), and provides a practical framework for nuclear medicine physicians to assess protocols and prepare their practices for expanding indications and combinations.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Building Sustainable Theranostics Programs: Operational Models, Access, and Equity. 建立可持续的治疗学项目：运营模式、准入和公平。
PET clinics Pub Date : 2026-05-04 DOI: 10.1016/j.cpet.2026.03.004
Chad Bassett, Anthony Chang, Laurie Placinski, Jeremiah Johns, Harshad R Kulkarni
{"title":"Building Sustainable Theranostics Programs: Operational Models, Access, and Equity.","authors":"Chad Bassett, Anthony Chang, Laurie Placinski, Jeremiah Johns, Harshad R Kulkarni","doi":"10.1016/j.cpet.2026.03.004","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.03.004","url":null,"abstract":"<p><p>Theranostics integrates molecular imaging with targeted radiopharmaceutical therapy to guide patient selection, treatment personalization, and response assessment using the same or closely related biologic target. The rapid clinical adoption of Lu-177 DOTATATE for neuroendocrine tumors and Lu-177 PSMA-617 for metastatic castration-resistant prostate cancer has shifted theranostics from a niche capability to a capacity-limited service line. Sustainable programs require more than drug procurement: they depend on fit-for-purpose facilities, trained multidisciplinary teams, compliant radiation safety and pharmaceutical quality systems, reliable isotope supply, and reimbursement models that support safe delivery.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Theranostics: When Targeted Imaging Guides Targeted Therapy. 治疗学：当靶向成像指导靶向治疗时。
PET clinics Pub Date : 2026-04-30 DOI: 10.1016/j.cpet.2026.03.003
Harshad R Kulkarni
{"title":"Theranostics: When Targeted Imaging Guides Targeted Therapy.","authors":"Harshad R Kulkarni","doi":"10.1016/j.cpet.2026.03.003","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.03.003","url":null,"abstract":"<p><p>Theranostics in nuclear medicine has traditionally referred to pairing a diagnostic scan with a matched radiopharmaceutical therapy. This review argues for a broader, target-centric framework. In this model, molecular imaging serves as an in vivo companion diagnostic that verifies target expression across the whole body and guides selection, initiation, and monitoring of targeted therapies. This paradigm extends beyond radiopharmaceutical therapy to include antibody-drug conjugates, immunotherapy, and endocrine therapy. As precision medicine evolves, theranostics is best understood as a clinical pathway linking target biology to treatment decisions through imaging.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Theranostics in Neuroendocrine Neoplasms: The Multifaceted Aspects Integrating Imaging, Therapy, and Dosimetry. 神经内分泌肿瘤的治疗：综合影像学、治疗和剂量学的多方面。
PET clinics Pub Date : 2026-04-30 DOI: 10.1016/j.cpet.2026.03.002
Aadil Adnan, Sandip Basu
{"title":"Theranostics in Neuroendocrine Neoplasms: The Multifaceted Aspects Integrating Imaging, Therapy, and Dosimetry.","authors":"Aadil Adnan, Sandip Basu","doi":"10.1016/j.cpet.2026.03.002","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.03.002","url":null,"abstract":"<p><p>The advent of theranostics-integrating molecular functional imaging with targeted radionuclide therapy-has revolutionized the management of Neuroendocrine neoplasms (NENs), particularly through peptide receptor radionuclide therapy. This comprehensive review examines the current state of theranostics in NENs, encompassing the molecular basis of somatostatin receptors (SSTR) targeting, diagnostic imaging modalities, therapeutic radiopharmaceuticals, dosimetry methodologies, patient selection criteria, treatment outcomes, toxicity profiles, and emerging innovations including α-emitting radionuclides and SSTR antagonists. By integrating these multifaceted aspects, this review aims to provide clinicians and researchers with a holistic understanding of theranostics in NENs and its transformative impact on precision oncology.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fibroblast Activation Protein: Molecular Imaging and Beyond. 成纤维细胞活化蛋白：分子成像及其他。
PET clinics Pub Date : 2026-04-29 DOI: 10.1016/j.cpet.2026.02.004
Sophie C Siegmund, Rudolf A Werner, Frederik L Giesel
{"title":"Fibroblast Activation Protein: Molecular Imaging and Beyond.","authors":"Sophie C Siegmund, Rudolf A Werner, Frederik L Giesel","doi":"10.1016/j.cpet.2026.02.004","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.02.004","url":null,"abstract":"<p><p>Fibroblast activation protein (FAP)-targeted PET/CT has been shown to provide high-contrast visualization of stromal activation across numerous desmoplastic tumors, being increasingly used in oncology. As interpretation challenges arise from benign fibroblastic processes, structured reporting is becoming indispensable. Although early explorations of FAP-targeted radionuclide therapy demonstrate feasibility, therapeutic translation remains constrained by rapid tracer washout and a lack of robust clinical trials. This review summarizes current FAP imaging applications along with theranostic approaches. Moreover, we will also shed light on the concept of image-guided strategies, where FAP PET can potentially determine the retention capacities in-vivo before on-set of novel nonradiolabeled, FAP-targeted drugs.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
State-of-the-Art Theranostics of Thyroid Cancer. 甲状腺癌的最新治疗技术。
PET clinics Pub Date : 2026-04-28 DOI: 10.1016/j.cpet.2026.03.006
Michael C Kreissl, Daniel A Hescheler, Andreas Pfestroff, Pietro Di Fazio, Friederike Eilsberger
{"title":"State-of-the-Art Theranostics of Thyroid Cancer.","authors":"Michael C Kreissl, Daniel A Hescheler, Andreas Pfestroff, Pietro Di Fazio, Friederike Eilsberger","doi":"10.1016/j.cpet.2026.03.006","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.03.006","url":null,"abstract":"<p><p>Theranostics of thyroid cancer has advanced significantly in recent years and now offers a wide range of options through new radiopharmaceuticals in addition to the established ones. The sodium-iodine remains the main target for differentiated thyroid cancer (DTC). [<sup>18</sup>F]fluorodeoxyglucose PET/CT is the gold standard for imaging more aggressive subtypes. Theranostics using radiopharmaceuticals with affinity to somatostatin receptors has been included in some guidelines as an option.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of PET in Radiation Oncology: A Theranostic Perspective on Detection of Radiation-Induced Complications. PET在放射肿瘤学中的作用：从治疗学角度检测放射引起的并发症。
PET clinics Pub Date : 2026-04-20 DOI: 10.1016/j.cpet.2026.03.005
Ehsan Ranjbar, Dia Avalur, Mukesh Kandra, Namratha Chembeti, Thomas Werner, Steven Feigenberg, Abass Alavi
{"title":"Role of PET in Radiation Oncology: A Theranostic Perspective on Detection of Radiation-Induced Complications.","authors":"Ehsan Ranjbar, Dia Avalur, Mukesh Kandra, Namratha Chembeti, Thomas Werner, Steven Feigenberg, Abass Alavi","doi":"10.1016/j.cpet.2026.03.005","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.03.005","url":null,"abstract":"<p><p>Radiation therapy remains essential in managing thoracic and head and neck malignancies, yet radiation-induced injury to surrounding normal tissues continues to pose significant clinical challenges. Traditional assessment of radiation complications relies on clinical symptoms and anatomic imaging, often detecting injury only after irreversible damage has occurred. This article reviews the emerging role of fluorodeoxyglucose PET/computed tomography (FDG-PET/CT) as a theranostic tool for early detection and quantitative assessment of radiation-induced complications across multiple organ systems. FDG-PET/CT exploits the increased glycolytic activity of inflamed tissues to identify subclinical radiation-induced injury to the surrounding healthy tissue before the onset of clinical symptoms.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial Intelligence Across the PSMA Theranostic Continuum in Prostate Cancer. 人工智能在前列腺癌PSMA治疗中的应用。
PET clinics Pub Date : 2026-04-10 DOI: 10.1016/j.cpet.2026.02.005
Gowtham Murugesan, Stephen Moore, Anthony Chang, Brandon Mancini, Harshad Kulkarni
{"title":"Artificial Intelligence Across the PSMA Theranostic Continuum in Prostate Cancer.","authors":"Gowtham Murugesan, Stephen Moore, Anthony Chang, Brandon Mancini, Harshad Kulkarni","doi":"10.1016/j.cpet.2026.02.005","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.02.005","url":null,"abstract":"<p><p>Prostate cancer is among the most common male malignancies worldwide, with recent advances in molecular imaging and targeted radiopharmaceutical therapy revolutionizing its management. PSMA has become a key theranostic target, enabling highly sensitive disease detection via PSMA PET/computed tomography (CT) imaging and effective treatment with PSMA-directed radioligand therapy. While PSMA theranostics are now standard in advanced prostate cancer care, increasing adoption strains specialist capacity and introduces variability in interpretation. Artificial intelligence (AI) and machine learning are poised to enhance this field by improving imaging accuracy, patient selection, treatment planning, and response monitoring.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
From Feasibility to Durability: The Next Phase of Theranostics. 从可行性到持久性：治疗学的下一阶段。
PET clinics Pub Date : 2026-04-09 DOI: 10.1016/j.cpet.2026.03.001
Harshad R Kulkarni, Abass Alavi
{"title":"From Feasibility to Durability: The Next Phase of Theranostics.","authors":"Harshad R Kulkarni, Abass Alavi","doi":"10.1016/j.cpet.2026.03.001","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.03.001","url":null,"abstract":"","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prostate-Specific Membrane Antigen Theranostics in Prostate Cancer - Current State and Evolving Standards. 前列腺癌的前列腺特异性膜抗原治疗-现状和发展标准。
PET clinics Pub Date : 2026-04-07 DOI: 10.1016/j.cpet.2026.02.002
Swayamjeet Satapathy, Kunal R Chandekar, Nishikant A Damle
{"title":"Prostate-Specific Membrane Antigen Theranostics in Prostate Cancer - Current State and Evolving Standards.","authors":"Swayamjeet Satapathy, Kunal R Chandekar, Nishikant A Damle","doi":"10.1016/j.cpet.2026.02.002","DOIUrl":"https://doi.org/10.1016/j.cpet.2026.02.002","url":null,"abstract":"<p><p>Prostate-specific membrane antigen (PSMA)-based theranostics represent a paradigm shift in the management of prostate cancer. PSMA-ligand PET/computed tomography has demonstrated superior diagnostic accuracy over conventional imaging across diverse clinical settings. Parallelly, robust phase 3 evidence has established [<sup>177</sup>Lu]Lu-PSMA-617 radioligand therapy as a standard-of-care in metastatic castration-resistant prostate cancer (mCRPC), with significant improvements in survival end points and quality of life. Emerging data also support the safe and effective integration of [<sup>177</sup>Lu]Lu-PSMA-617 into earlier disease settings, including chemotherapy-naïve mCRPC and metastatic hormone-sensitive prostate cancer. Collectively, PSMA theranostics exemplify the crucial role of nuclear medicine in advancing precision care for prostate cancer.</p>","PeriodicalId":94168,"journal":{"name":"PET clinics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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