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Nuclear medicine has an important role in oncology, both in the diagnostic/prognostic management of cancers, and in therapy.
With the exceptions of specific types of tumour, NM has limited role as first-line diagnostic procedure, instead it’s fundamental in the staging assessment of the patients after diagnosis of cancer has been established. Staging is crucial to assess prognosis and/or to select the most appropriate treatment(s) (surgery, adjuvant or neo-adjuvant therapy, combined regimens). In this context, PET is the most important NM applications and it has become standard of practice for many types of cancer.
Radionuclide imaging (especially if employing PET) does not rely purely on morphologic alterations, as it is the case for CT and MRI, but it rather identifies neoplastic alterations down to the metabolic level. Therefore, neoplastic involvement of lymph nodes, for instance, could be identified earlier. Metabolic-functional characterization is also important for assessing the efficacy of anti-tumour therapy as well as, during follow-up, for distinguishing abnormalities noted on morphologic imaging as due to either nonspecific post-treatment changes or to tumour recurrence.
Therapeutic applications of nuclear medicine are now expanding from a core of well-established procedures (such as radioiodine therapy in differentiated thyroid cancer, palliation of bone pain from skeletal metastases using bone-seeking agents, therapy of neuroblastoma or pheochromocytoma with 131I-MIBG) to newer applications covering a wider range of treatable malignacies (such as radioimmunotherapy of lymphomas and other malignancies, receptor-mediated therapy of neuroendocrine tumours with radiolabeled somatostatin analogues, etc).