Background/Objectives: Over the past four years, ⁶⁸Ga-fibroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography (PET/CT) has been established at a tertiary cancer care facility in Jordan. This retrospective study aims to explore tracer uptake metrics across various epithelial neoplasms, identify diagnostic pitfalls associated with ⁶⁸Ga-FAPI PET/CT, and evaluate the influence of ⁶⁸Ga-FAPI PET/CT staging results on changes in therapeutic intent compared to gold standard molecular imaging modalities. Methods: A total of 48 patients with biopsy-confirmed solid tumors underwent 77 ⁶⁸Ga-FAPI PET/CT examinations for molecular imaging assessment, encompassing neoplasms originating from the gastrointestinal tract, head and neck, hepatobiliary system, pancreas, breast, and lung. Results: Notably, pancreaticobiliary tumors exhibited the highest tracer uptake, with mean maximum standardized uptake values (SUVmax) and tumor-to-background ratios (TBR) surpassing 10. A comparative sub-analysis of ⁶⁸Ga-FAPI PET metrics in 20 treatment-naïve patients revealed a significant correlation between ⁶⁸Ga-FAPI uptake metrics and tumor grade (Spearman’s rho 0.83; p = 0.00001). Importantly, the results from ⁶⁸Ga-FAPI PET/CT influenced treatment decisions in 35.5% of the cases, primarily resulting in an escalation of management plans. A total of 220 diagnostic challenges were identified across 88.3% of the scans, predominantly within the musculoskeletal system, attributed to degenerative changes (99 observations). Conclusions: This comprehensive analysis highlights the potential significance of ⁶⁸Ga-FAPI PET/CT in oncological imaging and treatment strategy, while also emphasizing the necessity for meticulous interpretation to mitigate diagnostic challenges.

This retrospective study examines the diagnostic accuracy of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and neck magnetic resonance imaging (MRI) in detecting nodal metastasis for patients with laryngeal squamous cell carcinoma (LSCC) and assesses the predictive values of metabolic and structural features derived from ¹⁸F-FDG PET/CT. By involving 66 patients from 2014 to 2021, the sensitivity and specificity of both modalities were calculated. ¹⁸F-FDG PET/CT outperforms neck MRI for nodal disease detection, with 89% sensitivity, 65% specificity, and 77% accuracy for nodal metastasis (p = 0.03). On the other hand, neck MRI had 66% sensitivity, 62% specificity, and 64% accuracy. Approximately 11% of patients witnessed a change in their therapy intent when relying on ¹⁸F-FDG PET/CT nodal staging results. Analyzing the cohort for PET-derived metabolic and morphological parameters, a total of 167 lymph nodes (LN) were visualized. Parameters such as the LN maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and LN size were computed. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Among the 167 identified cervical LNs, 111 were histopathologically confirmed as positive. ROC analysis revealed the highest area under the curve for LN MTV (0.89; p < 0.01), followed by LN size (0.87; p < 0.01). Both MTV and LN size independently predicted LN metastasis through multivariate analysis. In addition, LN MTV can reliably predict false-positive LNs in preoperative staging, offering a promising imaging-based approach for further exploration.

Background: This systematic review and meta-analysis evaluates the safety and efficacy of emerging prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) agents used beyond [¹⁷⁷Lu]Lu-PSMA in metastatic castration-resistant prostate cancer (mCRPC). Methods: Systematic searches of PubMed, Web of Science, and Scopus were performed from inception until November 3, 2025. Studies reporting objective response rate (ORR), disease control rate (DCR), and/or toxicity outcomes were included. Meta-analytic pooling, assessment of publication bias, heterogeneity analyses, and subgroup evaluations were conducted using Stata software. Results: A total of 33 studies published between 2017 and 2025 met inclusion criteria, encompassing 3625 therapy cycles administered to 1525 patients. The pooled DCR was 86% (95% CI: 82–90%), and the pooled ORR was 57% (95% CI: 50–63%). [²²⁵Ac]Ac-PSMA monotherapy, evaluated in 17 studies, achieved pooled DCR and ORR values of 88% and 62%. Eight studies assessing [¹⁷⁷Lu]Lu/[²²⁵Ac]Ac-PSMA tandem therapy reported pooled DCR and ORR values of 84% and 51%. Five studies on [¹⁶¹Tb]Tb-PSMA demonstrated pooled DCR and ORR values of 81% and 46%. [¹³¹I]PSMA therapy, reported in three studies, resulted in a pooled DCR of 75% and pooled ORR of 48%. Adverse events were documented in 32 studies, with a pooled incidence of 26%. Most events were low-grade and reversible. Xerostomia and anemia were the most frequently reported toxicities, with xerostomia particularly associated with [²²⁵Ac]Ac-PSMA–containing regimens. Conclusion: These findings underscore the promising therapeutic potential of emerging PSMA RLT agents beyond [¹⁷⁷Lu]Lu-PSMA, with favorable biochemical responses and manageable safety profiles. Future large-scale prospective studies are essential to define optimal therapeutic roles and expand treatment opportunities for patients with mCRPC.

Laryngeal carcinoma is the most common head and neck cancer. The vast majority of laryngeal carcinomas are of squamous-cell histologic type. Metastasis of laryngeal cancer typically occurs within the cervical lymph nodes and seldom in other regions. Although a small percentage of patients experience distant metastases, bone marrow metastasis from laryngeal cancer is among the least common metastatic sites. Previous literature has suggested that bone marrow carcinomatosis is aggressive and has a poor outcome, particularly in patients with supraglottic tumors. Ante-mortem diagnosis of this metastatic pattern has been limited. To our knowledge, this case report highlights the first documented occurrence wherein the utilization of 18-fluorine fludeoxyglucose positron emission tomography/CT imaging played a pivotal role in the early detection of bone marrow metastasis in a patient diagnosed with transglottic laryngeal cancer. A solitary metastatic distant bone marrow lesion was identified early during follow-up. As a consequence, the patient exhibited a remarkable and unforeseen favorable clinical outcome.