Pôle d’imagerie, clinique de biophysique et médecine nucléaire, unité Inserm 877, hôpital Michallon, BP 217, CHU de Grenoble, 38043 Grenoble cedex 09, France
The growing success of isotopic explorations in oncology is related to the number of growing radiotracers and progress in the methods for detection and imaging. Today, the nuclear medicine is able to answer important questions raised by biology and therapeutic progress results from this. The new radiopharmaceutical compounds are able to explore in vivo the metabolism, the proliferation, the hypoxia and the expression of some receptors or antigens in tumor cells. This progress in radiopharmaceuticals design can be combined with the new tools for detection, such as the cameras coupled to a tomodensitometer (TEMP-TDM and TEP-TDM), the new gamma cameras with semiconductors, and the peroperative gamma probes. The nuclear medicine can now be used to determine the initial staging of tumours, the evaluation of residual disease, the detection of recurrence, the evaluation and the prediction of response to treatments, i.e. chemotherapy, radiotherapy and now targeted treatments. This led to very promising prospects in the therapeutic adaptation and in the patient follow-up, as clearly shown in the malignant lymphomas. Standardized international criteria are set up for the therapeutic evaluation in TEP-FDG. Today, the nuclear medicine belongs to the family of “markers of substitution”, participating more and more to the personalized medicine field.