Terence Wong

Overview:

1. Anatomic/functional oncologic Imaging: SPECT/CT, PET/CT, novel PET radiotracers

2. Radiotheranostics, Radionuclide therapy of cancer, Radiation Therapy Planning

3. Imaging biomarkers for guiding treatment strategies

4. Multicenter clinical trial development (NCI National Clinical Trials Network)

Positions:

Professor of Radiology

Radiology, Nuclear Medicine
School of Medicine

Professor in Medicine

Medicine, Medical Oncology
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

Residency, Diagnostic Radiology

Beth Israel Deaconess Medical Center

Fellowship, Nuclear Radiology

Beth Israel Deaconess Medical Center

Fellowship, Body Imaging

Beth Israel Deaconess Medical Center

Grants:

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
Awarded By
American College of Radiology Imaging Network
Role
Principal Investigator
Start Date
End Date

ACRIN Committee or Subcommittee Chair Agreement

Administered By
Radiology
Awarded By
American College of Radiology Imaging Network
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

Predictors of Survival in 211 Patients with Stage IV Pulmonary and Gastroenteropancreatic MIBG-Positive Neuroendocrine Tumors Treated with 131I-MIBG.

This retrospective analysis identifies predictors of survival in a cohort of patients with meta-iodobenzylguanidine (MIBG)-positive stage IV pulmonary and gastroenteropancreatic neuroendocrine tumor (P/GEP-NET) treated with 131I-MIBG therapy, to inform treatment selection and posttreatment monitoring. Methods: Survival, symptoms, imaging, and biochemical response were extracted via chart review from 211 P/GEP-NET patients treated with 131I-MIBG between 1991 and 2014. For patients with CT follow-up (n = 125), imaging response was assessed by RECIST 1.1 if images were available (n = 76) or by chart review of the radiology report if images could not be reviewed (n = 49). Kaplan-Meier analysis and Cox multivariate regression estimated survival and progression-free survival benefits predicted by initial imaging, biochemical response, and symptomatic response. Results: All patients had stage IV disease at the time of treatment. Median survival was 29 mo from the time of treatment. Symptomatic response was seen in 71% of patients, with the median duration of symptomatic relief being 12 mo. Symptomatic response at the first follow-up predicted a survival benefit of 30 mo (P < 0.001). Biochemical response at the first clinical follow-up was seen in 34% of patients, with stability of laboratory values in 48%; response/stability versus progression extended survival by 40 mo (P < 0.03). Imaging response (20% of patients) or stability (60%) at the initial 3-mo follow-up imaging extended survival by 32 mo (P < 0.001). Additionally, multiple 131I-MIBG treatments were associated with 24 mo of additional survival (P < 0.05). Conclusion: Therapeutic 131I-MIBG for metastatic P/GEP-NETs appears to be an effective means of symptom palliation. Imaging, biochemical, and symptomatic follow-up help prognosticate expected survival after 131I-MIBG therapy. Multiple rounds of 131I-MIBG are associated with prolonged survival.
Authors
Kane, A; Thorpe, MP; Morse, MA; Howard, BA; Oldan, JD; Zhu, J; Wong, TZ; Petry, NA; Reiman, R; Borges-Neto, S
MLA Citation
Kane, Ari, et al. “Predictors of Survival in 211 Patients with Stage IV Pulmonary and Gastroenteropancreatic MIBG-Positive Neuroendocrine Tumors Treated with 131I-MIBG.J Nucl Med, vol. 59, no. 11, Nov. 2018, pp. 1708–13. Pubmed, doi:10.2967/jnumed.117.202150.
URI
https://scholars.duke.edu/individual/pub1319377
PMID
29777005
Source
pubmed
Published In
Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
Volume
59
Published Date
Start Page
1708
End Page
1713
DOI
10.2967/jnumed.117.202150

FDG-PET/CT characterization of adrenal nodules: diagnostic accuracy and interreader agreement using quantitative and qualitative methods.

PURPOSE: To determine interreader agreement and diagnostic accuracy across varying levels of reader experience using qualitative and quantitative methods of evaluating adrenal nodules using ((18)F)-fluorodeoxyglucose-positron emission tomography/computed tomography. METHODS: 132 adrenal nodules (96 adenomas, 36 metastases) were retrospectively identified in 105 patients (49 men and 56 women, mean age 66 years, age range 45-85 years) with a history of lung cancer who underwent ((18)F)-fluorodeoxyglucose-positron emission tomography/computed tomography. For each nodule, three readers independently performed one qualitative and two quantitative measurements: visual assessment, standardized uptake value (SUVmax), and standard uptake ratio (SUVratio). Interreader agreement was calculated using percent agreement with κ statistic for qualitative analysis and intraclass correlation coefficient (ICC) for quantitative analysis. Accuracy, sensitivity, and specificity for distinguishing benign from malignant adrenal nodules were calculated for each method. RESULTS: Percent agreement between readers for visual (qualitative) assessment was 92% to 96% and κ statistic was 0.79 to 0.90 (95% confidence limits 0.66-0.99). ICC for SUVmax was 92% to 99% (95% CL 0.8-1.0), and ICC for SUVratio was 89% to 99% (95% CL 0.74-0.99). For diagnosis of malignancy, mean sensitivity and specificity for visual assessment were 80% and 97%, respectively. Mean sensitivity and specificity for SUVmax were 91% and 81%, respectively; for SUVratio, 90% and 80%. Mean diagnostic accuracy was 93%, 83%, and 84% for visual assessment, SUVmax, and SUVratio, respectively. CONCLUSION: Excellent interreader agreement is seen for quantitative and qualitative methods of distinguishing benign from malignant adrenal nodules. Qualitative analysis demonstrated higher accuracy but lower sensitivity compared with quantitative analysis.
Authors
Evans, PD; Miller, CM; Marin, D; Stinnett, SS; Wong, TZ; Paulson, EK; Ho, LM
MLA Citation
Evans, Paul D., et al. “FDG-PET/CT characterization of adrenal nodules: diagnostic accuracy and interreader agreement using quantitative and qualitative methods.Acad Radiol, vol. 20, no. 8, Aug. 2013, pp. 923–29. Pubmed, doi:10.1016/j.acra.2013.02.010.
URI
https://scholars.duke.edu/individual/pub953877
PMID
23830599
Source
pubmed
Published In
Acad Radiol
Volume
20
Published Date
Start Page
923
End Page
929
DOI
10.1016/j.acra.2013.02.010

Research Areas:

Diagnostic Imaging
Imaging, Three-Dimensional
Molecular Imaging
Radionuclide Imaging