Harun Ilhan

Ludwig-Maximilians-University of Munich | LMU · Department of Nuclear Medicine

Die transarterielle Radioembolisation (TARE) ist eine lokal ablative Therapieoption bei primären und sekundären Lebertumoren mit leberdominanter Erkrankung. Dieser Artikel gibt einen Überblick über die gängigsten Indikationen, die Patientenselektion, die Therapieplanung und -durchführung sowie die Nachsorge der Patienten. Der Fokus liegt auf Yttriu...

Zusammenfassung Konventionelle, radiologische Modalitäten wie die Ultraschalldiagnostik, CT- und MRT-Bildgebung sind der klinische Standard in der onkologischen Bildgebung primärer und sekundärer Lebertumore. In den letzten Jahrzehnten konnten nuklearmedizinische Verfahren, darunter insbesondere die PET/CT-Bildgebung, zusätzliche, molekulare Inform...

Zusammenfassung Im Rahmen der transarterielle Radioembolisation (TARE) werden überwiegend 90Y-markierten Glas- und Harzmikrosphären verwendet. Seit Kurzem sind mit 166Ho neue Mikrosphären auf Basis von Poly-L-Milchsäure verfügbar, welche auch in Deutschland zunehmend in der klinischen Routine eingesetzt werden. Aufgrund physikalischer Unterschiede...

Transarterial radioembolization (TARE) or synonymously used selective internal radiotherapy (SIRT) is a local ablative therapy option for primary and secondary liver tumors with liver-dominant disease. Close cooperation of interventional radiology and nuclear medicine is necessary for the successful implementation of this therapy. This detailed edu...

Zusammenfassung Die transarterielle Radioembolisation (TARE) mit radioaktiv markierten Mikrosphären dient der gezielten Therapie primärer und sekundärer Lebertumore. Bei 90Y-markierten Glas- und Harzmikrosphären basiert die Behandlungsplanung auf 99mTc-MAA, während für 166Ho-PLAA-Mikrosphären eine Scout-Dosis an 166Ho-PLAA-Mikrosphären mit geringer...

Purpose: With the increased use of focal radiation dose escalation for primary prostate cancer (PCa), accurate delineation of gross tumor volume (GTV) in prostate-specific membrane antigen PET (PSMA-PET) becomes crucial. Manual approaches are time-consuming and observer dependent. The purpose of this study was to create a deep learning model for t...

5010 Background: PSMA-PET was positive for distant metastases (39% distant nodes, 24% bone, 6% visceral organ) in >50% of nmCRPC pts who were nonmetastatic by conventional imaging (Fendler et al. CCR 2019). However, the prognostic impact of PSMA-PET disease extent and its association with oncologic outcomes is unknown. We assessed the prognostic ut...

1024 Background: Estrogen receptors (ER) are considered predictive biomarkers to identify ER+ MBC patients who would likely benefit from endocrine therapies (ET). However, 30 to 40% of ER+ MBC patients fail to achieve a durable response. 18F-FES PET/CT has been shown to represent a valuable and accurate diagnostic tool to determine ER status at the...

Background ¹⁷⁷Lu-PSMA therapy has been successfully used to prolong the survival of patients with metastatic castration-resistant prostate cancer. Patient-specific dosimetry based on serial quantitative SPECT/CT imaging can support the understanding of dose–effect relationships. However, multiple SPECT/CT measurements can be challenging for patient...

Salvage elective nodal radiotherapy (sENRT) is a treatment option for biochemical persistent or recurrent patients with lymph node metastases (LN) after prostatectomy. Possible ENRT templates were proposed by the RTOG (2009), the PIVOTAL trialists (2015) and the NRG Oncology Group (2021). The goal of this study was to analyze the distribution of PS...

Purpose Somatostatin analogues (SSA) are frequently used in the treatment of neuroendocrine tumours. Recently, [ ¹⁸ F]SiTATE entered the field of somatostatin receptor (SSR) positron emission tomography (PET)/computed tomography (CT) imaging. The purpose of this study was to compare the SSR-expression of differentiated gastroentero-pancreatic neuro...

Therapy options for advanced pancreatic neuroendocrine tumors (pNETs) include the mTOR inhibitor everolimus and peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-TATE, however further optimization in the therapeutic landscape is required as response rates are still low. In this study, we investigated the synergistic and potentially e...

Introduction Small intestine neuroendocrine neoplasms (siNENs) will attain more importance due to their increasing incidence. Moreover, siNENs might lead to a desmoplastic reaction (DR) of the mesentery causing severe complications and deteriorating prognosis. The expression of fibrosis-related proteins appears to be the key mechanisms for the deve...

Im Rahmen der Primärabklärung von neuroendokrinen Tumoren (NET) kommen neben der Ultraschalldiagnostik die Computertomografie und die Magnetresonanztomografie zum Einsatz. Je nach Verfügbarkeit stellt darüber hinaus die funktionelle Bildgebung mittels Szintigrafie bzw. Single-Photon-Emissionscomputertomografie (SPECT) und Positronenemissionstomogra...

Background: PSMA-based alpha therapy using 225Ac-PSMA-I&T provides treatment for metastatic castration-resistant prostate cancer (mCRPC), even after the failure of 177Lu-PSMA radioligand therapy (RLT). In clinical routine, the total tumor volume (TTV) on PSMA PET impacts therapy outcomes and plays an increasing role in mCRPC patients. Hence, we aim...

Background ⁶⁸ Ga-EMP-100 is a novel positron emission tomography (PET) ligand that directly targets tumoral c-MET expression. Upregulation of the receptor tyrosin kinase c-MET in renal cell carcinoma (RCC) is correlated with overall survival in metastatic disease (mRCC). Clinicopathological staging of c-MET expression could improve patient manageme...

Radioembolization is the selective application of radionuclide-loaded microspheres into liver arteries for the therapy of liver tumours and metastases. In this review, we focused on therapy planning and dosimetry, as well as the main indications of 90Y-glass and resin microspheres and 166Ho-microspheres.

This bi-centric, retrospective analysis investigates the efficacy of PET/CT with novel theranostic PSMA-targeting ligand, 18F-rhPSMA-7, in patients with biochemical recurrence (BCR) of prostate cancer following curative-intent primary radiotherapy. Methods: Datasets from patients with BCR of prostate cancer following EBRT or brachytherapy who under...

Purpose Nodal recurrent prostate cancer (PCa) represents a common state of disease, amenable to local therapy. PSMA-PET/CT detects PCa recurrence at low PSA levels. The aim of this study was to evaluate the outcome of PSMA-PET/CT-based salvage radiotherapy (sRT) for lymph node (LN) recurrence. Methods A total of 100 consecutive patients treated wi...

Purpose Somatostatin analogues (SSA) are frequently used in the treatment of neuroendocrine tumours. Recently, [¹⁸F]SiTATE entered the field of somatostatin receptor (SSR) positron emission tomography (PET)/ computed tomography (CT) imaging. The purpose of this study was to compare the SSR-expression of differentiated gastroentero-pancreatic neuroe...

Background: The aim was to assess ablation success after initial radioiodine (RAI) therapy in early-stage PTC patients and compare outcomes of first diagnostic control after 6 and 9 months (6m/9m-DC) to examine whether time could possibly avoid unnecessary overtreatment. Methods: There were 353 patients who were matched regarding age, sex, and t...

Background: Academic research is important to face unmet medical needs. The Oncological community encounters many hurdles in setting up multicenter investigator-driven trials mainly due to administrative complexity. The purpose of a network organization at a multinational level is to facilitate clinical trials through standardization, coordination,...

Zusammenfassung Die Eindämmung und Tumorkontrolle von Lebermetastasen ist von entscheidender Bedeutung für das Überleben von Patienten mit metastasierten Malignomen unterschiedlicher Entitäten, insbesondere auch bei neuroendokrinen Tumoren (NETs). Lokal ablative und lokoregionäre therapeutische Verfahren stellen sichere und effektive Therapieoption...

Neuroendocrine tumors (NET) are relatively rare tumor entities arising from neuroendocrine cells primarily located in the stomach, duodenum, and pancreas. Imaging methods for the primary diagnosis of NET are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Furthermore, molecular imaging using single-photon emission compute...

Background: Left ventricular mechanical dyssynchrony (LVMD) and left ventricular function are intertwined. Gated myocardial perfusion SPECT (MPS) and gated fluorodeoxyglucose positron emission computed tomography (FDG PET) are an elegant way for repeated assessment of myocardial dyssynchrony and myocardial function. To the knowledge of the authors...

Background Prostate specific membrane antigen (PSMA) PET imaging has recently gained attention in glioblastoma (GBM) patients as a potential theranostic target for PSMA radioligand therapy. However, PSMA PET has not yet been established in a murine GBM model. Our goal was to investigate the potential of PSMA PET imaging in the syngeneic GL261 GBM m...

IntroductionProstate-specific membrane antigen (PSMA)-based radioligand therapy (RLT) showed in a multicentre WARMTH (World Association of Radiopharmaceutical and Molecular Therapy) study that the presence of bone metastases is a negative prognosticator for the survival. The current multicentre retrospective analysis aims to evaluate the response r...

Abstract223Radium (Ra) dichloride (Radium-223, Xofigo®; Bayer AG, Germany) is the first targeted alpha therapy to prolong survival in adult patients with castration-resistant prostate cancer, symptomatic bone metastases, and no known visceral metastases. Particularly in light of recent updates to the 223radium approval, centers for nuclear medicine...

Trans-arterial radioembolization (TARE) is increasingly evaluated for unresectable intrahepatic cholangiocarcinoma (ICC). Not all ICC patients benefit equally well from TARE. Therefore, we sought to evaluate variables predicting progression-free survival (PFS) and overall survival (OS). Patients with non-resectable ICC underwent TARE and were treat...

Background: In patients with poorly differentiated thyroid carcinoma, the clinical course and prognostic value of response to initial radioiodine therapy is evaluated. Methods: In 47 patients, clinical and imaging features were analyzed. Patients were stratified in no (NED), biochemical (B-ED) and structural evidence of disease (S-ED) assessed a...

Purpose Radiolabelled somatostatin analogues targeting somatostatin receptors (SSR) are well established for combined positron emission tomography/computer tomography (PET/CT) imaging of neuroendocrine tumours (NET). [ ¹⁸ F]SiTATE has recently been introduced showing high image quality, promising clinical performance and improved logistics compared...

Background: The most important cause of heart transplant loss is early acute allograft rejection, caused by the infiltration of lymphocytes, development of edema and myocardial necrosis. It has been propagated that [68Ga]DOTA-TATE PET might be suitable to quantify the presence of SSTR over-expressing lymphocytes. With heterotopic allogenic heart t...

Background Target volume definition of the primary tumor in esophageal cancer is usually based on computed tomography (CT) supported by endoscopy and/or endoscopic ultrasound and can be difficult given the low soft-tissue contrast of CT resulting in large interobserver variability. We evaluated the value of a dedicated planning [F18] FDG-Positron e...

This comprehensive review written by experts in their field gives an overview on the current status of incorporating positron emission tomography (PET) into radiation treatment planning. Moreover, it highlights ongoing studies for treatment individualisation and per-treatment tumour response monitoring for various primary tumours. Novel tracers and...

The aim of this study was to evaluate the role of SUV and ADC in assessing early response in patients with NELM following TARE. Thirty-two patients with pre- and postinterventional MRI with DWI and 68Ga-DOTATATE PET/CT were included. ADC and SUV of three target lesions and of tumor-free spleen and liver tissue were determined on baseline and first...

Background: To evaluate quantitative myocardial perfusion SPECT/CT datasets for routine clinical reporting and the assessment of myocardial tracer uptake in patients with severe TVCAD. Methods: MPS scans were reconstructed as quantitative SPECT datasets using CTs from internal (SPECT/CT, Q_INT) and external (PET/CT, Q_EXT) sources for attenuatio...

Background Due to partly conflicting studies, further research is warranted with the QGS software package, with regard to the performance of gated FDG PET phase analysis as compared to gated MPS as well as the establishment of possible cut-off values for FDG PET to define dyssynchrony. Methods Gated MPS and gated FDG PET datasets of 93 patients we...

This comprehensive review written by experts in their field gives an overview on the current status of incorporating positron emission tomography (PET) into radiation treatment planning. Moreover, it highlights ongoing studies for treatment individualisation and per-treatment tumour response monitoring for various primary tumours. Novel tracers and...

Background In patients with hepatic neuroendocrine tumors (NETs) locoregional therapies such as transarterial radioembolization (TARE) are increasingly applied. Response evaluation remains challenging and previous studies assessing response with diffusion-weighted imaging (DWI) have been inconclusive. Purpose To perform a feasibility study to eval...

Background The aim of this work was to investigate the outcome of metastasis-directed radiotherapy (MDT) in prostate cancer patients with bone metastases following current ESTRO/EORTC subclassifications for oligometastatic disease. Methods Clinical data of 80 consecutive oligometastatic patients with 115 bone lesions receiving MDT between 2011 and...

Introduction Tyrosine kinase (TKI) and checkpoint inhibitors (CI) prolonged overall survival in metastatic renal cell carcinoma (mRCC). Early prediction of treatment response is highly desirable for the individualization of patient management and improvement of therapeutic outcome; however, serum biochemistry is unable to predict therapeutic effica...

Background Delineation of PSMA-positive tumor volume on PET using PSMA-ligands is of highest clinical interest as changes of PSMA-PET/CT-derived whole tumor volume (WTV) have shown to correlate with treatment response in metastatic prostate cancer patients. So far, WTV estimation was performed on PET using ⁶⁸Ga-labeled ligands; nonetheless, ¹⁸F-lab...

Simple Summary Radioembolization has failed to prove survival benefit in randomized trials, and, depending on various factors including tumor biology, response rates may vary considerably. Studies showed positive correlations between survival and absorbed tumor dose. Therefore, increasing currently prescribed tumor doses may be favorable for improv...

Following publication of the original article [1], it was reported that due to a typesetting error some text was mistakenly introduced in the “MC method: Patient-specific Monte Carlo (MC) absorbed dose simulation” and “Comparison of dosimetry methods” subsections. The erroneous text is highlighted in bold in the below passages and has been removed...

PET using 68Ga-labeled somatostatin receptor (SSTR) ligands adds significant information in meningioma patients. 18F-SiTATE is a novel, 18F-labeled SSTR-targeting peptide with remarkable imaging properties. Here, we present a 72-year-old woman with falx meningioma and transosseous extension. 18F-SiTATE PET/CT was performed 12 months after the previ...

Background Patients with metastatic, castration-resistant prostate cancer (mCRPC) present with an increased tumor burden in the skeleton. For these patients, Lutetium-177 (Lu-177) radioligand therapy targeting the prostate-specific membrane antigen (PSMA) has gained increasing interest with promising outcome data. Patient-individualized dosimetry e...

Background: Dosimetry can tailor prostate-specific membrane-antigen-targeted radioligand therapy (PSMA-RLT) for metastatic castration-resistant prostate cancer (mCRPC). However, whole-body tumor dosimetry is challenging in patients with a high tumor burden. We evaluate a simplified index-lesion-based single-photon emission computed tomography (SPE...

We present a 71-year-old female patient who underwent 18F-PSMA-1007 PET/CT for suspected metastatic renal cell carcinoma (RCC), as RCC also shows high PSMA-expression in tumor neovascularization. 18F-PSMA-1007 PET/CT showed a high PSMA-avidity in the renal tumor, enlarged intra-abdominal and mediastinal lymph nodes. Moreover, PSMA-positive pleural,...

Neuroendocrine tumors (NETs) are relatively rare neoplasms arising from the hormone-producing neuroendocrine system that can occur in various organs such as pancreas, small bowel, stomach and lung. As the majority of these tumors express somatostatin receptors (SSR) on their cell membrane, utilization of SSR analogs in nuclear medicine is a promisi...

Background Sarcoid lesions may mimic metastatic disease or recurrence in thyroid cancer (TC) patients as both diseases may affect the lungs and lymph nodes. We present the first study to systematically evaluate the clinical course of patients with (TC) after adjuvant radioactive iodine therapy (RIT) and concomitant sarcoidosis of the lung or the ly...

PurposeThere are controversial debates if patients with Hürthle cell carcinoma, also known as oxyphilic or oncocytic cell follicular thyroid carcinoma, have a poorer outcome. In this study, we systematically evaluated the clinical outcome in a large patient cohort following thyroidectomy and initial I-131 radioactive iodine therapy (RIT).Methods We...

Background: The tyrosine kinase inhibitor (TKI) Lenvatinib represents one of the most effective therapeutic options in patients with advanced radioiodine refractory differentiated thyroid carcinoma (DTC). We aimed to assess the role of 2-deoxy-2-[18F] fluoro-D-glucose positron-emission-tomography/computed-tomography (18F-FDG-PET/CT) in the monitor...

An 82-year-old man suffering from prostate cancer that was scheduled for a radioreceptor-ligand therapy (RLT) presented with jaundice to our service. An abdominal ultrasound (US) revealed obstructive extrahepatic cholestasis due to a solid lesion located in the uncinate process of the pancreas. The Prostate Specific Membrane Antigen (PSMA) PET/CT p...

Background/aim: Intraarterial Technetium-99m-Macroaggregated Albumin (99mTc-MAA) administration is an established method to predict particle distribution prior to radioembolization. This study aimed to analyse the impact of intraarterial administration of 99mTc-MAA on changes in liver-specific laboratory parameters and to assess whether such chang...

Introduction: The impact of prior therapies, especially chemotherapy, on overall survival (OS) in patients with castration-resistant prostate cancer (CRPC) receiving [177Lu]Lu-PSMA-617 therapy has been the subject of controversy. Therefore, WARMTH decided to plan a multicenter retrospective analysis (the "617 trial") to evaluate response rate and...

Background To improve therapy outcome of Yttrium-90 selective internal radiation therapy (⁹⁰Y SIRT), patient-specific post-therapeutic dosimetry is required. For this purpose, various dosimetric approaches based on different available imaging data have been reported. The aim of this work was to compare post-therapeutic 3D absorbed dose images using...

Simple Summary In this bi-institutional analysis including 421 patients, we report an overall high biochemical-recurrence free survival rate (58% after three years) after positron-emission tomography (PET)-based salvage radiotherapy (sRT). Additionally, the strong prognostic effect of prostate specific antigen (PSA) level prior to sRT in this patie...

Background: Extrathyroidal extension of differentiated thyroid cancer is a poor outcome factor but seems to be less significant in minimal extrathyroidal extension (mETE). However, the impact of mETE on response rate after (adjuvant) initial radioactive iodine (RAI) therapy remains unclear. We therefore compared response rates of patients with cla...

Background In recent years nuclear medicine theranostics using radiolabeled prostate-specific membrane antigen (PSMA) ligands have gained increasing importance in the management of prostate cancer.AimThe aim of this work is to highlight the value of theranostic concepts using radiolabeled PSMA ligands for both the diagnostic work-up and treatment o...

Aim/Introduction: Although metastatic, castration-resistant prostate cancer (mCRPC) patients undergoing Lu-177-PSMA therapy show a large number of bone metastasis, tumor dosimetry is typically performed only for a limited number of lesions per patient. To differentiate between responding/non-responding bone lesions, dosimetric calculation for all b...

Background: Treatment of advanced metastatic castration resistant prostate cancer (mCRPC) after failure of approved therapy options remains challenging. Prostate-specific membrane antigen (PSMA) targeting β- and α-emitters have been introduced with promising response rates. Here, we present the first clinical data for PSMA targeted α-therapy (TAT)...

Aim/Introduction: Ac-225-PSMA therapy is a promising option for patients suffering from metastasized prostate cancer. Although Ac-225 shows a noticeable gamma emission (e. g. 26 % for 440 keV), image-based dosimetry via quantitative SPECT is challenging due to the low therapeutic activities. Further, imaging of the 440 keV photopeak shows a complex...

Background Patients with metastatic, castration-resistant prostate cancer (mCRPC) present with an increased tumor burden in the skeleton. For these patients, Lutetium-177 (Lu-177) radioligand therapy targeting the prostate-specific membrane antigen (PSMA) has gained increasing interest with promising outcome data. Patient-individualized dosimetry e...

Introduction [¹⁸F]SiTATE (formerly known as [¹⁸F]SiFAlin-TATE) was recently introduced as a highly promising imaging agent for the diagnosis of well-differentiated neuroendocrine tumors (NET) using positron emission tomography/computed tomography (PET/CT). A high tumor uptake and excellent image quality, the straightforward labeling approach, as we...

Background: Radioembolization (RE) is well established in the treatment of neuroendocrine liver metastases. However surgery is rarely performed after RE, although liver resection is the gold standard in the treatment of localized neuroendocrine liver metastases. Therefore, aim of the present study was to evaluate the safety and feasibility of live...

Background In recent years nuclear medicine theranostics using radiolabeled prostate-specific membrane antigen (PSMA) ligands have gained increasing importance in the management of prostate cancer.AimThe aim of this work is to highlight the value of theranostic concepts using radiolabeled PSMA ligands for both the diagnostic work-up and treatment o...

Purpose Peptide receptor radionuclide therapy (PRRT) with [¹⁷⁷Lu]Lu-DOTA⁰,TYR³-octreotate ([¹⁷⁷Lu]Lu-DOTA-TATE) and the mechanistic target of rapamycin (mTOR) inhibitor everolimus are both approved for the treatment of neuroendocrine tumours (NET). However, tumour progression is still frequent, and treatment strategies need further improvement. One...

Radiotherapy and radiation oncology play a key role in the clinical management of patients suffering from oncological diseases. In clinical routine, anatomic imaging such as contrast-enhanced CT and MRI are widely available and are usually used to improve the target volume delineation for subsequent radiotherapy. Moreover, these modalities are also...

Introduction PET/CT using ⁶⁸Ga-labeled somatostatin analogs (SSA) targeting somatostatin receptors (SSR) on the cell surface of well-differentiated neuroendocrine tumors (NET) represents the clinical reference standard for imaging. However, economic and logistic challenges of the ⁶⁸Ge/⁶⁸Ga generator-based approach have disadvantages over ¹⁸F-labele...