Radio-guided surgery with beta emission. Status and perspectives

Surgery is a key treatment for localized or locally advanced solid tumors. However, the application of wide safety margins can result in significant side effects and functional limitations for the patient. On the contrary, tissue-sparing surgery may leave residual tumor, which can lead to local recurrent cancer or distant metastases. To address these problems, intraoperative radio-guidance, such as beta radio-guided surgery (RGS), could be used to detect small cancerous tissue and selectively resect malignant areas. This paper provides a comprehensive review of RGS based on beta emission, focusing on the physical principles that differentiate beta radiation from gamma radiation, which is already commonly used in nuclear medicine. Although beta RGS was proposed several decades ago, its popularity has recently increased, possibly due to the widespread use of newly developed PET radiotracers. Various approaches are currently being investigated to assess the effectiveness of beta RGS, including the use of both beta+ and beta- emitting radiopharmaceuticals. Beta RGS has unique characteristics that make it a promising complementary technique to standard procedures. Encouraging results have been obtained in numerous ex vivo and in vivo tests. However, clinical trials are needed to demonstrate the real clinical value of these promising technologies. The references presented represent the most impactful works in the development of beta RGS, according to the authors. Papers were selected from a Scopus search with keywords "radio-guided surgery" and "beta emitter".