Improvements in personalized therapy are made possible by the advances in molecular biology that led to developments in molecular imaging, allowing highly specific in vivo imaging of biological processes

Positron emission tomography (PET) is the most specific and sensitive imaging technique for in vivo molecular targets and pathways, offering quantification and evaluation of functional properties of the targeted anatomy.

Currently, there is the general consensus that the focus in oncology is reoriented towards personalized therapy for better treatment outcome and quality of life. Improvements in personalized therapy are made possible by the advances in molecular biology that led to developments in molecular imaging.

The area of research is growing, by allowing highly specific and accurate in vivo imaging of biological processes that cover a diverse spectrum of molecular events, from cell-specific (such as EGFR or stemness) to tumor microenvironment specific (such as VEGF).

While its presence in tumors and role in treatment response is known for over half a century, tumor hypoxia remains one of the leading causes of treatment failure in radiotherapy. Beside cellular radioresistance, hypoxia also promotes angiogenesis which leads to further tumor development, and distant metastasis

Treatment outcome

This work is an integrative research review that summarizes and evaluates the accumulated current status of knowledge of recent advances in PET imaging for cancer diagnosis and treatment, concentrating on novel radiotracers and evaluating their advantages and disadvantages in cancer characterization.

Medline search was conducted, limited to English publications from 2007 onward. Identified manuscripts were evaluated for most recent developments in PET imaging of cancer hypoxia, angiogenesis, proliferation, and clonogenic cancer stem cells (CSC).

There is an expansion observed from purely metabolic-based PET imaging toward antibody-based PET to achieve more information on cancer characteristics to identify hypoxia, proangiogenic factors, CSC, and others. 64Cu-ATSM, for example, can be used both as a hypoxia and a CSC marker.

Progress in the field of functional imaging will possibly lead to more specific tumor targeting and personalized treatment, increasing tumor control and improving quality of life.