Nuclear Medicine

18F-FDG PET/CT alters MDT plans in ~1 in 5 adults with abdominal malignancy

Meta-analysis of seven studies found PET/CT changed multidisciplinary management in 21.8% of adults with abdominal malignancies (95% CI 10.6–33.0%). Reported changes included cancellation or addition of planned surgery, modification of surgical extent, and shifts between curative and palliative intent. Between-study heterogeneity was substantial, and evidence on survival, quality of life, and cost-effectiveness was limited. Apply PET/CT to clarify staging in ambiguous cases and to inform surgical candidacy, but expect variable impact by tumor type. 1

Trials labeled 'personalized' are heterogeneous, low transparency, and high bias

Survey of 262 RCTs using 'personalized/individualized/precision' found most interventions were non-genomic and heterogeneous. Abstracts favored personalized interventions in 70.6% of comparative trials, despite sparse data sharing and only 5.0% reporting data availability. Most trials (68.6%) were judged at high overall risk of bias and code sharing was nearly absent. When reading 'personalized' RCTs, scrutinize methods, prespecification, and transparency before changing practice. 2

Baseline testosterone modifies docetaxel mortality benefit in high-risk nonmetastatic prostate cancer

Predictive biomarker analysis in discovery (n=255) and validation (n=563) cohorts showed docetaxel plus RT and ADT reduced all-cause mortality only in patients with normal baseline testosterone. Treatment-by-testosterone interaction reached significance in both cohorts (p=0.048 and p=0.042). Patients with normal testosterone and high-risk features (PSA >20, T3/4, Gleason 9/10) derived the most benefit. Consider baseline testosterone when discussing docetaxel addition, acknowledging this is a secondary predictive analysis. 3