Page 69 - ARNM-1-2

Advances in Radiotherapy
& Nuclear Medicine Immunochemoradiotherapy in malignant pleural mesothelioma

epithelioid malignant mesothelioma. D2-40 exhibits fibrocyte proliferation and inflammatory changes within
a high positive rate in epithelioid mesothelioma and a the thyroid. Subsequent telephone consultations and
negative expression in lung adenocarcinoma. The patient CT imaging follow-up data, as of May 29, 2023, indicate
underwent F-FDG PET/CT imaging before the initiation process-free survival >17.2 months, local recurrence-free
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of treatment. After the imaging, the patient received survival >17.2 months, distant metastasis-free survival
four cycles of chemotherapy featuring pemetrexed in >17.2 months, and overall survival >17.2 months for
combination with nedaplatin and camrelizumab, alongside the patient. These findings support the effectiveness of
radiotherapy (DT: 5000 cGy/25 f). Three months after immunochemotherapy combined with radiotherapy in the
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completing the treatment, F-FAPI-04 PET/CT imaging treatment of patients.
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was performed. F-FDG PET/CT images obtained before
treatment (Figure 1J-M, R) displayed left pleural effusion, 3. Discussion
diffuse thickening of the left pleura, and pathologically Recent studies have demonstrated that FAPI PET/CT,
elevated F-FDG accumulation in the left pleura, with when compared with FDG PET/CT, may offer certain
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a maximal standard uptake value (SUVmax) of 6.6. In advantages in the detection of primary tumor and
contrast, the F-FAPI-04 images acquired after treatment peritoneal metastasis in various malignancies, including
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(Figure 1N-Q, S) displayed a reduction in lesion area and gastric cancer, liver cancer, benign non-inflammatory
reduced F-FAPI-04 accumulation in the left pleura, now focal liver lesions, differentiated thyroid cancer, as well as
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exhibiting an SUVmax of 4.96 (tumor to background ratio: lesions in the lymphatic, skeletal, pleural, and pulmonary
3.06). These findings suggest that immunochemotherapy regions [1-4] . Utilizing Ga-FAPI-04, which targets fibroblast
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and radiotherapy resulted in a reduction in lesion extent activating protein, shows great potential in the diagnosis
and uptake, indicating an effective treatment response. of a wide range of cancers and sarcomas [5,6] . While CT
The F-FDG PET/CT images (Figure 2A-F) taken before scans are commonly employed methods for evaluating
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the patient’s treatment revealed the presence of multiple therapeutic efficacy in cases of malignant pleuroma, they
[7-11]
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lymph nodes in the bilateral supraclavicular regions, with do have inherent limitations . Compared with CT, F-
no observed increased uptake of FDG. In addition, there FDG PET scans can detect metabolic changes at an earlier
were no abnormal FDG uptakes observed in the bilateral stage, proving valuable in assessing the treatment response
[12,13]
thyroid lobes. Following treatment, the 18 F-FAPI-04 in patients with malignant pleural mesothelioma .
image (Figure 2G-L) displayed no notable changes in However, the criteria for evaluating FDG PET scans have
the bilateral lymph nodes, with no increased uptake not been standardized, and FDG PET tends to exhibit
[11,14]
of FAPI-04. However, a marked contrast was observed lower sensitivity in the context of low-grade tumors .
in the F-FAPI-04 PET/CT imaging, which revealed Previous studies have also demonstrated that Ga-FAPI
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diffuse increased uptake of FAPI-04 in the thyroid region. PET/CT exhibits a superior capability for detecting
Thyroid function tests confirmed an increase in levels of primary tumors and lymph node metastases in malignant
antithyroid microsomal antibody and antithyroglobulin pleural mesothelioma when compared to F-FDG PET,
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antibody. This finding suggests that the elevated FAPI- making Ga-FAPI PET/CT a promising tool for the
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04 uptake in the thyroid may be attributed to abnormal evaluation of malignant pleural mesothelioma [4,15-17] . Both
A B C D E F

G H I J K L

Figure 2. (A-F) F-fluorodeoxyglucose ( F-FDG) positron emission tomography/computed tomography images: The white arrows and blue arrows
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indicate multiple lymph nodes on the bilateral supraclavicular with no increased FDG uptake. The red arrows indicate no abnormal FDG uptake in
bilateral thyroid lobes. (G-L) F-fibroblast-activating protein inhibitor (FAPI)-04 images: The white arrows and blue arrows indicate the same multiple
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lymph nodes with no increased FAPI-04 uptake. The red arrows indicate diffuse FAPI-04 uptake in the thyroid (SUV = 4.86 with tumor-to-background
max
ratio: 3.06).
Volume 1 Issue 2 (2023) 3 https://doi.org/10.36922/arnm.0963