Radiopharmaceutical Theranostics in Primary Adrenal Malignancies: A Surgeon's Perspective.

Area of Science:

• Oncology
• Nuclear Medicine
• Surgical Oncology

Background:

• Radiopharmaceutical theranostics combines targeted imaging and therapy.
• Established for prostate, thyroid, hepatocellular cancers, and neuroendocrine tumors (NETs).
• Adrenal malignancies, including pheochromocytoma/paraganglioma (PPGL) and adrenocortical cancer (ACC), require specialized management with distinct molecular targets.

Purpose of the Study:

• To review the role of radiopharmaceutical theranostics in adrenal malignancies.
• To explore the implications of theranostic advances for surgical decision-making.
• To integrate clinical evidence and multidisciplinary considerations for adrenal cancer surgery.

Main Methods:

• Narrative review of existing clinical evidence.
• Integration of multidisciplinary practice considerations.
• Focus on theranostic advances and their impact on surgical management.

Main Results:

• Radiotheranostic approaches are established for specific cancers but less explored for adrenal malignancies.
• Pheochromocytoma/paraganglioma (PPGL) and adrenocortical cancer (ACC) utilize different molecular targets and radiopharmaceuticals.
• Current literature predominantly focuses on nuclear medicine perspectives, overlooking surgical implications.

Conclusions:

• Theranostic advances are reshaping treatment paradigms for adrenal malignancies.
• There is a need to better understand and integrate theranostics into surgical decision-making for PPGL and ACC.
• Multidisciplinary collaboration is crucial for optimizing the role of surgery in managing these complex cancers.