theranostic-study

Neuroendocrine Tumors

Neuroendocrine tumours are rare tumours that develop from neuroendocrine cells. These cells have the traits of hormone-producing cells and nerve cells. They are found all over the body. Symptoms depend on the site and the type of neuroendocrine tumour. Most neuroendocrine tumours have somatostatin receptors which can be detected on the Ga68-dotapeptide scan. Patients with advanced and non-operable neuroendocrine tumours that show uptake on the dotapeptide scans can be treated with Lu-177 Dotatate therapy or peptide receptor radionuclide therapy (PRRT). Our department was one of the first in the region to offer this treatment option and our experience dates back to 2012. Our research activities include the long term follow up of our patients to evaluate the outcomes and improve patient selection. We are also involved in trials in collaboration with our radiation and medical oncologists looking at the use of dotapeptide scans and therapy in other somatostatin positive tumours such as nasopharyngeal carcinoma.

Contact:

Please contact Dr Tham Wei Ying, email: tham.wei.ying@singhealth.com.sg for more information.

Publications:

Low HC, Tay YS, Ong SYK, Tham WY, Yan SX. Peptide Receptor Radionuclide Therapy Performed Shortly after administration of Long-Acting Octreotide. Clin Nucl Med 2023; 48(12): 1086-1088. Available from DOI: 10.1097/RLU.0000000000004906.
Low HC, Loke KSH, Wang FQ, Han S, Nei WL. 68Ga-DOTATATE PET/CT of Metastatic Lymphoepithelial Carcinoma of Parotid Gland. Clin Nucl Med 2023; 48(12): 1056-1058. Available from DOI: 10.1097/RLU.0000000000004899.
Koo SX, AK Tong, SY Soh, M Farid, A Loh, KS Loke. Selective use of Peptide Receptor Radionuclide Therapy following comparative imaging of Ga-68 DOTATATE PET/CT against I-131 MIBG scintigraphy in a small Asian cohort of Adult neuroblastoma. Med J Malaysia 2021; 76(4):573-577.
Tang CYL, Chua WM, Huang HL, Lam WWC, Loh LM, Tai D, Ong SYK, Yan SX, Loke KSH, Ng DCE, Tham WY. Safety and efficacy of peptide receptor radionuclide therapy in patients with advanced pheochromocytoma and paraganglioma: A single-institution experience and review of the literature. J Neuroendocrinol. 2023;e13349. doi:10.1111/jne.13349

Hepatocellular Cancer & Liver Metastases

Liver cancer is the 5th most common cancer in men in Singapore in the years 2017-2021, with more than 2,900 cases reported in these 5 years. There have been significant advances in the diagnosis and treatment of these tumours in the last 2 decades, but many aspects are still unknown, especially relating to the genomic-metabolomic-biologic intercorrelations and tumour heterogeneity. The department has been involved in research in liver cancer (hepatocellular carcinomas and cholangiocarcinomas), in conjunction with liver surgeons, gastroenterologists, interventional radiologists, radiation oncologists, medical oncologists, pathologists and the research eco-system of SINGHEALTH-DUKE NUS. Research areas include data analytics on overall survival, progression free survivals, Y90-PET imaging, partition-modelling, voxel dosimetry and biological tumour response. The department was an early investigator of the cellular effects of Y90 microspheric radiation in tumour immunomodulation, and clinical evaluation of Y90 microspheres with immune checkpoint inhibitors. Multi-sites international trials includes SIRFLOX, SIVERNIB and STRATUM.

Contact:

Please contact Prof David Ng Chee Eng, email: david.ng.c.e@singhealth.com.sg for more information.

Publications:

Goh Anthony Soon-Whatt; Chung Alexander Yaw-Fui; Lo Richard Houa-Gong; Lau Te-Neng; Yu Sidney Wing-Kwong; Chng May; Satchithanantham Somanesan; Loong Susan Li-Er; Ng David Chee-Eng; Lim Beng-Choo; Connor Stephen; Chow Pierce Kah-Hoe. A novel approach to brachytherapy in hepatocellular carcinoma using a phosphorous32 (32P) brachytherapy delivery device--a first-in-man study. International Journal of Radiation Oncology, Biology, Physics 2007; 67(3):786-792.
Kao Yung Hsiang; Hock Tan Andrew Eik; Burgmans Mark Christiaan; Irani Farah Gillian; Khoo Li Ser; Gong Lo Richard Hoau; Tay Kiang Hiong; Tan Bien Soo; Hoe Chow Pierce Kah; Eng Ng David Chee; Whatt Goh Anthony Soon. Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling for safe and effective 90Y radioembolization. Journal of Nuclear Medicine 2012; 53(4):559-566.
Andrew Yu-Keat Khor, Ying Toh, John Carson Allen, David Chee-Eng Ng, Yung-Hsiang Kao, Guili Zhu, Su-Pin Choo, Richard Hoau-Gong Lo, Kiang-Hiong Tay, Jin-Yao Teo, Brian Kim-Poh Goh, Mark Christiaan Burgmans, Farah Gillian Irani, Anthony Soon-Whatt Goh, Pierce Kah-Hoe Chow. Survival and pattern of tumor progression with yttrium-90 microsphere radioembolization in predominantly hepatitis B Asian patients with hepatocellular carcinoma. Hepatology International 2014; 8:395-404.
Pierce KH Chow, Richard HG Lo, David WM Tai, Kiang Hiong Tay, Kelvin SH Loke, Chow Wei Too, Kiat Hon Lim, Su Pin Choo, Michael LC Wang, Brian KP Goh, Anthony SW Goh, Sue Ping Thang, Farah Gillian Irani, Choon Hua Thng, David CE Ng, Han Chong Toh, Jen San Wong, Sean X Yan, Apoorva Gogna, Sum Leong. National Cancer Centre Singapore Consensus Guidelines for Hepatocellular Carcinoma. Liver Cancer 2016; 5(2):97-106.
Chew V, Lee YH, Pan L, Nasir NJM, Lim CJ, Chua C, Lai L, Hazirah SN, Lim TKH, Goh BKP, Chung A, Lo RHG, Ng D, Filarca RLF, Albani S, Chow PKH. Immune activation underlies a sustained clinical response to Yttrium-90 radioembolisation in hepatocellular carcinoma. Gut 2019; 68: 335-346.
Chow PKH, Gandhi M, Tan SB, Khin MW, Khasbazar A, Ong J, Choo SP, Cheow PC, Chotipanich C, Lim K, Lesmana LA, Manuaba TW, Yoong BK, Raj A, Law CS, Cua IHY, Lobo RR, Teh CSC, Kim YH, Jong YW, Han HS, Bae SH, Yoon HK, Lee RC, Hung CF, Peng CY, Liang PC, Bartlett A, Kok KYY, Thng CH, Low AS, Goh ASW, Tay KH, Lo RHG, Goh BKP, Ng DCE, Lekurwale G, Liew WM, Gebski V, Mak KSW, Soo KC; Asia-Pacific Hepatocellular Carcinoma Trials Group. SIRveNIB : Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma. J Clin Oncology 2018; 36(19):1913-1921.
Tong Aaron KT; Kao Yung Hsiang; Too Chow Wei; Chin Kenneth FW; Ng David CE; Chow Pierce KH. Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry. British J Radiology 2016; 89: 43.

Prostate Cancer

In Singapore, prostate cancer is the most frequent incident cancer diagnosed and 5th most common cause of cancer-related deaths in men from 2017 to 2021. Over the last decade, Nuclear Medicine involvement in the management of prostate cancer is primarily related to the high accuracy of prostate-specific membrane antigen (PSMA) PET/CT scan for detection of prostate cancer, and individualized treatment with PSMA-targeted radioligand therapy for prostate cancer with high PSMA expression. Our research activities include analyzing and publishing our clinical experience, as well as involvement in multisite international trials such as AMG 160, PSMAddition, and upcoming PSMA Care and OMPC. Notably, we have also been involved in the international studies (ALSYMPCA and ERA 223 using Radium-223 dichloride in prostate cancer patients with symptomatic bone metastases.

Contact:

Please contact Asst Prof Thang Sue Ping, email: thang.s.p@singhealth.com.sg for more information.

Publications:

⁶⁸Gallium-labelled PSMA-PET/CT as a diagnostic and clinical decision-making tool in Asian prostate cancer patients following prostatectomy. Tan JSH, Goh CXY, Koh YS, Li Y, Tuan JKL, Chua ET, Tan TWK, Wang MLC, Lee LS, Tay KJ, Kanesvaran R, Toh CK, Tong AKT, Lam WWC, Chua MLK. Cancer Biol Med. 2019 Feb;16(1):157-166. doi: 10.20892/j.issn.2095-3941.2018.0288.
Clinical outcomes of 177lutetium-prostate-specific membrane antigen therapy in advanced prostate cancer-a prospective pilot study in an Asian population. Thang SP, Lam WWC, Tong AKT, Allen JC Jr, Ler ASL, Tay YS, Somanesan S, Kanesvaran R, Wong ASC, Ng DCE.Nucl Med Commun. 2020 Jul;41(7):618-628. doi: 10.1097/MNM.0000000000001179.
Outcomes and prognostic predictors of Lu-177 PSMA radioligand therapy in metastatic castration-resistant prostate cancer (Asian Population Study). Chua WM, Lam WW, Tong AK, Sultana R, Kua SMY, Kanesvaran R, Wong ASC, Tay KJ, Cheng TJL, Ng DCE, Thang SP. Asia Pac J Clin Oncol. 2023 Mar 31. doi: 10.1111/ajco.13944.
Optimization of Bayesian penalized likelihood reconstruction for 68 Ga-prostate-specific membrane antigen-11 PET/computed tomography. Tang CYL, Lim GKY, Chua WM, Ng CWQ, Koo SX, Goh CX, Thang SP, Zaheer S, Lam WWC, Huang HL.Nucl Med Commun. 2023 Jun 1;44(6):480-487. doi: 10.1097/MNM.0000000000001687.
Head-to-head Comparison of the Diagnostic Accuracy of Prostate-specific Membrane Antigen Positron Emission Tomography and Conventional Imaging Modalities for Initial Staging of Intermediate- to High-risk Prostate Cancer: A Systematic Review and Meta-analysis. Chow KM, So WZ, Lee HJ, Lee A, Yap DWT, Takwoingi Y, Tay KJ, Tuan J, Thang SP, Lam W, Yuen J, Lawrentschuk N, Hofman MS, Murphy DG, Chen K. Eur Urol. 2023 Jul;84(1):36-48. doi: 10.1016/j.eururo.2023.03.001

Thyroid Cancer

Differentiated thyroid cancer is the 2nd most common cancer diagnosed in Singaporean women below the age of 40 years and overall, the 8th most common cancer in women. The incidence of thyroid cancer has been steadily increasing globally. Nuclear Medicine plays a unique role in the diagnosis and treatment of patients with thyroid cancer. Our department, together with our surgical and endocrinology collaborators, has been actively researching on improving care and novel treatments for thyroid cancer patients such as the study of radiation dosimetry using I-124 and redifferentiation therapy with MEK and BRAF inhibitors.

Successful redifferentiation of iodine-refractory disease with subsequent I-131 treatment and interval partial response

Contact:

Please contact A/Prof Kelvin Loke, email: kelvin.loke.s.h@singhealth.com.sg for more information.

Publications:

Post-thyroidectomy Neck Ultrasonography in Patients With Thyroid Cancer and A Review of the Literature. Sumbul Zaheer, Andrew Eik Hock Tan, Ee Sin Ang, Kelvin S.H. Loke, Yung Hsiang Kao, Anthony Goh, Wai Yin Wong. Singapore Medical Journal 55(4):177-83 April 2014
Yung Hsiang Kao, Hui Kong Gan, Sumbul Zaheer, Winnie W C Lam, Kelvin S H Loke, Wai Yin Wong, David C E Ng, Anthony S W Goh. Gender, Race, and Age at Diagnosis as risk factors for metastasis or recurrence among 1,657 Thyroid cancer patients treated with Radioiodine across 40 years in Singapore. Oncol Res Treat 2015:18;38(12):679-82
Recombinant human thytropin versus thyroid hormone withdrawal in an Asian population. Charlene Tang, Sue Ping Thang, Sumbul Zaheer, Chung Kong Kwan, David Chee-Eng Ng. Endocrine 69(1) July 2020
Frequent Neck US in Papillary Thyroid Cancer Likely Detects Non-Actionable Findings. Kathleen Su-Yen Sek, Ingrid Tsang, Xuan Yong Lee, Omar H Albaqmi, Yanina Jimena Morosan Allo, Melanie Rosmarin, Azhar K Mahrous, Rajeev Parameswaran, David Chee Eng Ng, Aaron Kian Ti Tong, Kelvin S.H. Loke, Gabriela Brenta, Abdullah Hassan Alghamdi, Naif A Albati, Stephanie A Fish, R Michael Tuttle, Samantha Peiling Yang. Clinical Endocrinology 94(4) Sep 2020
A Multiplex Thyroid-Specific Assay for Quantification of Circulating Thyroid Cell-Free RNA in Plasma of Thyroid Cancer Patients. Samantha Peiling Yang, Lian Chye Winston Koh, Kiat Whye Kong, Rajeev Parameswaran, Kelvin S.H. Loke, Kee Yuan Ngiam, Wee Boon Tan, Thomas Loh, David Chee Eng Ng, Boon Cher Goh, Joanne Ngeow, E-Shyong Tai. Frontiers in Genetics 12 Aug 2021
Adjuvant Treatment and Follow-Up of Thyroid Cancers. Endocrine Surgery 2022

Other Cancers

The Department of Nuclear Medicine and Molecular Imaging strives to be at the forefront of nuclear theranostics, to research and discover new radiopharmaceuticals which might become clinically relevant. This often involves the discovery of novel compounds or discovering new ways to treat existing diseases. We are currently collaborating with medical and radiation oncologists to treat nasopharyngeal carcinoma with peptide receptor radionuclide therapy.

Contact:

Please contact A/Prof Kelvin Loke, email: kelvin.loke.s.h@singhealth.com.sg for more information.

Correlation between DOTATATE and FDG uptake with EBER staining on histology

Publications:

Matt Lechner, Volker H. Schartinger, Christopher D. Steele, Wen Long Nei, Marc L. Ooft, Liesa-Marie Schreiber, Christodoulos P. Pipinikas, Grace Tin-Yun Chung, Yuk Yu Chan, Feng Wu, Ka-Fai To, Chi Man Tsang, Wayne Pearce, Daniele Morelli, Martin Philpott, Liam Masterson, Reshma Nibhan, Graham Wells, Christopher G. Bell, Julia Koller, Susanne Delecluse, Yim Ling Yip, Jacklyn Liu, Cillian T. Forde, Martin D. Forster, Amrita Jay, József Dudás, Annika Krapp, Simon Wan, Christian Uprimny, Susanne Sprung, Tim R. Fenton, Kerry Chester, Christina Thirlwell, Teresa Marafioti , Rajeev Gupta, Sagung Rai Indrasari, Camelia Herdini, Mohd Afiq Mohd Slim, Liam Sutton, Renske Fles, Bing Tan, Joe Yeong, Amit Jain, Hai Tao Wang, Kelvin S.H. Loke, Wan He, Ruilian Xu, Hongtao Jin, Zhiqiang Cheng, David Howard, Peter H. Hwang, Quynh-Thu Le, Joshua K. Tay, Robert B. West, Sai Wah Tsao, Tim Meyer, Herbert Riechelmann, Udo Oppermann, Henri-Jacques Delecluse, Stefan M. Willems, Melvin L.K. Chua, Pierre Busson, Kwok Wai Lo, Guido Wollmann, Nischalan Pillay, Bart Vanhaesebroeck, Valerie J. Lund. Somatostatin receptor 2 expression in nasopharyngeal cancer is induced by Epstein Barr virus infection: impact on prognosis, imaging and therapy. Nature Communications 12(1) Jan 2021
Arjunan Kumaran, Si Xuan Koo, Joe Young, Anglea Maria Takano, Mohamad Farid, Siu Hoong Loke, Wen Long Nei. Imaging and treatment with 68Gallium and 177Lutetium-DOTATATE in a rare SSTR2 and ESWR1-CREM fusion positive undifferentiated round cell tumour of the lung. BJR.
Wen-Long Nei, Amit Jain, Fu-Qiang Wang, Lih Kin Khor, Joe Poh-Sheng Yeong, Shu-Ting Han, Kiattisa Sommat, Mei Kim Ang, Yoke Lim Soong, Kelvin Siu Hoong Loke. Somatostatin receptor imaging in nasopharyngeal cancer. Annals of Nasopharyx Cancer, Jan 2018Boon Fei Tan, Wei Chang Colin Tan, Fu Qiang, Wang, Matt Lechner, Volker Schartinger, Daniel Shao Weng Tan, Kelvin Siu Hoong Loke, Wen Long Nei. PSMA PET imaging and therapy in adenoid cystic carcinoma and other salivary gland cancers: a systemic review. Cancers 2022, 14(15), 3585

Theranostic Study

Neuroendocrine Tumors

Hepatocellular Cancer & Liver Metastases

Prostate Cancer

Thyroid Cancer

Other Cancers