Terence Wong

Overview:

1. Oncologic Imaging: PET/CT, novel PET radiotracers

2. Radionuclide therapy of cancer, Radiation Therapy Planning

3. Image-guided radiation therapy treatment planning

4. Hyperthermia

Positions:

Professor of Radiology

Radiology, Nuclear Medicine
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1990

Dartmouth College

Ph.D. 1990

Dartmouth College

Fellow, Interventional & Intraoperative Mri

Children's Hospital, Boston

Grants:

Phase II Study of 44Gy from 131I-81C6 for CNS Tumors

Administered By
Neurosurgery, Neuro-Oncology
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Radiation-Induced Cardiopulmonary Injury in Humans

Administered By
Radiation Oncology
Awarded By
National Institutes of Health
Role
Investigator
Start Date
End Date

Predicting Human Tumor Response by 31p MRS

Administered By
Radiology, Neuroradiology
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Simultaneous Emission and Transmission Mammotomography

Administered By
Radiology
Awarded By
National Institutes of Health
Role
Investigator
Start Date
End Date

ECOG-ACRIN Operations Center Grant

Administered By
Radiology, Nuclear Medicine
Role
Principal Investigator
Start Date
End Date

Publications:

Molecular Imaging and Therapy for Neuroendocrine Tumors.

OPINION STATEMENT: Neuroendocrine tumors (NETs) are relatively rare, with 12,000-15,000 new cases diagnosed annually in the USA. Although NETs are a diverse group of neoplasms, they share common molecular targets that can be exploited using nuclear medicine techniques for both imaging and therapy. NETs have traditionally been imaged with SPECT imaging using 111In-labeled octreotide analogs to detect neoplasms with somatostatin receptors. In addition, certain NETs (pheochromocytomas, paragangliomas, and neuroblastomas) are also effectively imaged using 123I- or 131I-labeled metaiodobenzylguanidine (MIBG), an analog of guanethidine. More recently, PET imaging with 68Ga-labeled somatostatin receptor (SSR) analogs allows neuroendocrine tumors to be imaged with much higher sensitivity. 68Ga-DOTATATE was approved as a PET tracer by the FDA in June 2016. In addition to imaging, both MIBG and DOTATATE can be labeled with therapeutic radionuclides to deliver targeted radiation selectively to macroscopic and microscopic tumor sites. The incorporation of the same molecular probe for imaging and therapy provides a radio-theranostic approach to identifying, targeting, and treating tumors. Over the years, several centers have experience treating NETs with high-dose 131I-MIBG. 177Lu-DOTATATE was approved by the FDA in 2018 for treatment of gastroenteropancreatic NETs and constitutes a major advancement in the treatment of these diseases. In this paper, we provide an overview of imaging and treating neuroendocrine tumors using MIBG and SSR probes. Although uncommon, neuroendocrine tumors have provided the largest experience for targeted radionuclide imaging and therapy (with the exception of radioiodine treatment for thyroid disease). In addition to benefitting patients with these rare tumors, the knowledge gained provides a blueprint for the development of future paired diagnostic/therapeutic probes for treating other diseases, such as prostate cancer.
Authors
MLA Citation
Desai, Hemant, et al. “Molecular Imaging and Therapy for Neuroendocrine Tumors.Curr Treat Options Oncol, vol. 20, no. 10, Aug. 2019, p. 78. Pubmed, doi:10.1007/s11864-019-0678-6.
URI
https://scholars.duke.edu/individual/pub1406491
PMID
31468190
Source
pubmed
Published In
Current Treatment Options in Oncology
Volume
20
Published Date
Start Page
78
DOI
10.1007/s11864-019-0678-6

Feasibility of optimizing the dose distribution in lung tumors using fluorine-18-fluorodeoxyglucose positron emission tomography and single photon emission computed tomography guided dose prescriptions.

The information provided by functional images may be used to guide radiotherapy planning by identifying regions that require higher radiation dose. In this work we investigate the dosimetric feasibility of delivering dose to lung tumors in proportion to the fluorine-18-fluorodeoxyglucose activity distribution from positron emission tomography (FDG-PET). The rationale for delivering dose in proportion to the tumor FDG-PET activity distribution is based on studies showing that FDG uptake is correlated to tumor cell proliferation rate, which is shown to imply that this dose delivery strategy is theoretically capable of providing the same duration of local control at all voxels in tumor. Target dose delivery was constrained by single photon emission computed tomography (SPECT) maps of normal lung perfusion, which restricted irradiation of highly perfused lung and imposed dose-function constraints. Dose-volume constraints were imposed on all other critical structures. All dose-volume/function constraints were considered to be soft, i.e., critical structure doses corresponding to volume/function constraint levels were minimized while satisfying the target prescription, thus permitting critical structure doses to minimally exceed dose constraint levels. An intensity modulation optimization methodology was developed to deliver this radiation, and applied to two lung cancer patients. Dosimetric feasibility was assessed by comparing spatially normalized dose-volume histograms from the nonuniform dose prescription (FDG-PET proportional) to those from a uniform dose prescription with equivalent tumor integral dose. In both patients, the optimization was capable of delivering the nonuniform target prescription with the same ease as the uniform target prescription, despite SPECT restrictions that effectively diverted dose from high to low perfused normal lung. In one patient, both prescriptions incurred similar critical structure dosages, below dose-volume/function limits. However, in the other patient, critical structure dosage from the nonuniform dose prescription exceeded dose-volume/function limits, and greatly exceeded that from the uniform dose prescription. Strict compliance to dose-volume/ function limits would entail reducing dose proportionality to the FDG-PET activity distribution, thereby theoretically reducing the duration of local control. Thus, even though it appears feasible to tailor lung tumor dose to the FDG-PET activity distribution, despite SPECT restrictions, strict adherence to dose-volume/function limits could compromise the effectiveness of functional image guided radiotherapy.
Authors
Das, SK; Miften, MM; Zhou, S; Bell, M; Munley, MT; Whiddon, CS; Craciunescu, O; Baydush, AH; Wong, T; Rosenman, JG; Dewhirst, MW; Marks, LB
URI
https://scholars.duke.edu/individual/pub714696
PMID
15259648
Source
pubmed
Published In
Medical Physics
Volume
31
Published Date
Start Page
1452
End Page
1461
DOI
10.1118/1.1750991

Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis.

PURPOSE: To assess whether radiographic and metabolic changes on midchemoradiation therapy (CRT) fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) for cervical cancer predict outcome. METHODS AND MATERIALS: Women with International Federation of Gynecology and Obstetrics stage IB1-IVB cervical cancer treated with concurrent cisplatin-based CRT and brachytherapy were enrolled on a single-institution prospective clinical trial; FDG-PET/CT was obtained before CRT and at 30 to 36 Gy. Max and mean standard uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) for the primary tumor and clinically involved lymph nodes from the pre-CRT and intra-CRT FDG-PET/CT were recorded. Clinical endpoints analyzed include overall survival (OS), disease-free survival (DFS), and rates of cervical recurrence (CR), nodal recurrence (NR), and distant metastasis (DM). FDG-PET/CT variables and other prognostic factors associated with clinical endpoints were identified via univariate Cox proportional hazards modeling and competing risk analysis. RESULTS: Thirty women were enrolled from 2012 to 2016. After a median follow-up of 24 months, 2-year rates of OS, DFS, DM, NR, and CR were 68% (95% confidence interval [CI], 51%-85%), 44% (95% CI, 26%-63%), 42% (95% CI, 23%-59%), 14% (95% CI, 4%-30%), and 10% (95% CI, 2%-24%), respectively. Intra-PET metrics and TLG across all PET scans were most consistently associated with OS, DFS, DM, and NR on univariate analysis. Intra-CRT TLG was associated with OS (hazard ratio [HR] 1.35; 95% CI, 1.15-1.55; P = .001), DFS (HR 1.19; 95% CI, 1.04-1.34; P = .018), and NR (HR 1.25; 95% CI, 1.10-1.40; P = .002). No absolute or relative changes between parameters of baseline and mid-CRT FDG-PET/CT were associated with disease outcomes on univariate analysis, with the exception of relative change in mean standard uptake values and CR (P = .004). CONCLUSIONS: In this group of patients with high-risk cervical cancer treated with CRT and brachytherapy, TLG and metabolic tumor volume on intra-CRT FDG-PET/CT was associated with OS. These metrics may provide an early signal for selective treatment intensification with either dose escalation or adjuvant chemotherapy.
Authors
Carpenter, DJ; Jacobs, CD; Wong, TZ; Craciunescu, O; Chino, JP
MLA Citation
Carpenter, David J., et al. “Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis.Int J Radiat Oncol Biol Phys, vol. 105, no. 2, Oct. 2019, pp. 356–66. Pubmed, doi:10.1016/j.ijrobp.2019.06.2506.
URI
https://scholars.duke.edu/individual/pub1395940
PMID
31254659
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
105
Published Date
Start Page
356
End Page
366
DOI
10.1016/j.ijrobp.2019.06.2506

Impact of ¹⁸F-florbetapir PET imaging of β-amyloid neuritic plaque density on clinical decision-making.

¹⁸F-florbetapir positron emission tomography (PET) imaging of the brain is now approved by the Food and Drug Administration (FDA) approved for estimation of β -amyloid neuritic plaque density when evaluating patients with cognitive impairment. However, its impact on clinical decision-making is not known. We present 11 cases (age range 67-84) of cognitively impaired subjects in whom clinician surveys were done before and after PET scanning to document the theoretical impact of amyloid imaging on the diagnosis and treatment plan of cognitively impaired subjects. Subjects have been clinically followed for about 5 months after the PET scan. Negative scans occurred in five cases, leading to a change in diagnosis for four patients and a change in treatment plan for two of these cases. Positive scans occurred in six cases, leading to a change in diagnosis for four patients and a change in treatment plan for three of these cases. Following the scan, only one case had indeterminate diagnosis. Our series suggests that both positive and negative florbetapir PET scans may enhance diagnostic certainty and impact clinical decision-making. Controlled longitudinal studies are needed to confirm our data and determine best practices.
Authors
Zannas, AS; Doraiswamy, PM; Shpanskaya, KS; Murphy, KR; Petrella, JR; Burke, JR; Wong, TZ
MLA Citation
Zannas, Anthony S., et al. “Impact of ¹⁸F-florbetapir PET imaging of β-amyloid neuritic plaque density on clinical decision-making.Neurocase, vol. 20, no. 4, Aug. 2014, pp. 466–73. Pubmed, doi:10.1080/13554794.2013.791867.
URI
https://scholars.duke.edu/individual/pub947914
PMID
23672654
Source
pubmed
Published In
Neurocase
Volume
20
Published Date
Start Page
466
End Page
473
DOI
10.1080/13554794.2013.791867

Initial In Vivo Quantification of Tc-99m Sestamibi Uptake as a Function of Tissue Type in Healthy Breasts Using Dedicated Breast SPECT-CT.

A pilot study is underway to quantify in vivo the uptake and distribution of Tc-99m Sestamibi in subjects without previous history of breast cancer using a dedicated SPECT-CT breast imaging system. Subjects undergoing diagnostic parathyroid imaging studies were consented and imaged as part of this IRB-approved breast imaging study. For each of the seven subjects, one randomly selected breast was imaged prone-pendant using the dedicated, compact breast SPECT-CT system underneath the shielded patient support. Iteratively reconstructed and attenuation and/or scatter corrected images were coregistered; CT images were segmented into glandular and fatty tissue by three different methods; the average concentration of Sestamibi was determined from the SPECT data using the CT-based segmentation and previously established quantification techniques. Very minor differences between the segmentation methods were observed, and the results indicate an average image-based in vivo Sestamibi concentration of 0.10 ± 0.16 μCi/mL with no preferential uptake by glandular or fatty tissues.
Authors
Mann, SD; Perez, KL; McCracken, EKE; Shah, JP; Wong, TZ; Tornai, MP
MLA Citation
Mann, Steve D., et al. “Initial In Vivo Quantification of Tc-99m Sestamibi Uptake as a Function of Tissue Type in Healthy Breasts Using Dedicated Breast SPECT-CT.J Oncol, vol. 2012, 2012, p. 146943. Pubmed, doi:10.1155/2012/146943.
URI
https://scholars.duke.edu/individual/pub802493
PMID
22956950
Source
pubmed
Published In
J Oncol
Volume
2012
Published Date
Start Page
146943
DOI
10.1155/2012/146943