Radionuclide therapy revisited

Abstract

Apart from its use in endocrinology and rheumatology, therapeutic nuclear medicine is developing rapidly as an additional treatment modality in oncology. Many different specific tumour-seeking radiopharmaceuticals are being applied both for diagnostic scintigraphy and treatment, using multiple routes and mechanisms to target radionuclides at tumours. After a brief introduction of some basic principles of radionuclide targeting, the therapeutic radiopharmaceuticals available are reviewed according to the accumulation site in relation to the cell nucleus; the results of their current clinical use for therapy are also reviewed. The response observed to a number of these applications, the non-invasiveness of the procedure and the relative lack of toxicity and late effects in comparison with chemotherapy and external beam radiotherapy make radionuclide therapy an attractive and realistic alternative in the management of malignant disease, as well as in the treatment of a few benign disorders.

Therapeutic radionuclides in nuclear medicine: current and future prospects

“…The requirements for a therapeutic radionuclide may be divided into two main categories, namely physical and biochemical characteristics (Hoefnagel, 1991). The considerations for physical characteristics include the physical half-life, type of emissions, energy of the radiation(s), daughter product(s), method of production, and radionuclide purity (Troutner, 1987;Hoefnagel, 1991;Volkert et al, 1991). The biochemical aspects include tissue targeting, retention of radioactivity in the tumour, in vivo stability, and toxicity (Zweit, 1996;Kassis and Adelstein, 2005).…”

“…In the last twenty years, radionuclide therapy has been widely used in various clinical malignant and pain management applications (Hoefnagel, 1991;Nakabeppu and Nakajo, 1994;vande Streek et al, 1994;Forrer et al, 2006;Williams et al, 2008;Lambert et al, 2010;Nestor, 2010;Chiacchio et al, 2011;Ersahin et al, 2011;Carrasquillo et al, 2012;Ezziddin et al, 2012;Gabriel, 2012;Gulenchyn et al, 2012;Dash et al, 2013;Sainz-Esteban and Baum, 2013). Radionuclide therapy has the advantage of delivering a highly concentrated absorbed dose to the targeted tumour while sparing the surrounding normal tissues.…”

Interferon and meta-iodobenzylguanidin combinations in the treatment of metastatic carcinoid tumours

“…Although reduction in tumour growth is rarely reported, stable disease is described in a substantial proportion of the patients (Taal et al 1996, Caplin et al 1998, Mukherjee et al 2001, Pathirana et al 2001. Worldwide experience with 131 I-MIBG diagnostic imaging has indicated a cumulative sensitivity of 70% in 237 patients with carcinoid tumours (Hoefnagel 1991). Predosing with unlabelled MIBG resulted in improved tumour targeting, biochemical response and hence prolonged palliation (Zuetenhorst et al 1999.…”

Nuclear medicine 2013: from status quo to status go

“…In 1991, a comprehensive review of radiotherapeutics was published [1]. This review described about 40 substances that appeared to be promising probes for various disease pathways.…”

“…Since then only few therapeutic drugs have been developed and adopted for routine use: Y-particles/microspheres (for the treatment of liver metastases). While several radiolabelled antibodies and the first somatostatin analogue were also presented in that early paper [1], it was only in 2012 that the FDA approved of the first 90 Y-radiolabelled antibody (Zevalin) [2]. Today, in 2013, first somatostatin analogues ( Also, from an imaging perspective, nuclear medicine has a lot to add to the management of patients.…”