The role of PET in imaging of the tumour microenvironment and response to immunotherapy

Positron emission tomography (PET) is an exquisitely sensitive molecular imaging technique with broad utility in cancer diagnosis and monitoring. Many ligands labelled with positron-emitting isotopes have been developed that are of interest in the field of cancer imaging. This review intends to provide an overview and outlook of PET in the field of oncology using radiotracers beyond that of the now widespread 2-deoxy-2-[F-18]-fluoro-D-glucose (F-18-FDG). A particular focus is the role of PET in understanding and monitoring the tumour microenvironment (TME) in response to chemo-radiotherapy. Furthermore priority will be given to aspects where PET has provided for monitoring of the immune response to cancer including the expanding field of cancer immunotherapy and in the arena of theranostics. The development of new techniques from both preclinical and human studies will be included to give a perspective on future directions, thereby helping to illustrate the importance of PET in cancer patient management. (C) 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.