Current Status of Radiopharmaceutical Therapy

Journal Article · Mon Mar 15 04:00:00 EDT 2021 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2020.08.035· OSTI ID:23198630

Bednarz, Bryan ^[1]; Benedict, Stanley ^[2]; Buchsbaum, Jeffrey C. ^[3]; Dewaraja, Yuni ^[4]; others, and

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1. Department of Medical Physics and Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison (United States)
2. Department of Radiation Oncology, University of California Davis, Sacramento (United States)
3. Radiation Research Program, Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda (United States)
4. Department of Radiology, University of Michigan, Ann Arbor (United States)

In radiopharmaceutical therapy (RPT), a radionuclide is systemically or locally delivered with the goal of targeting and delivering radiation to cancer cells while minimizing radiation exposure to untargeted cells. Examples of current RPTs include thyroid ablation with the administration of {sup 131}I, treatment of liver cancer with {sup 90}Y microspheres, the treatment of bony metastases with {sup 223}Ra, and the treatment of neuroendocrine tumors with {sup 177}Lu-DOTATATE. New RPTs are being developed where radionuclides are incorporated into systemic targeted therapies. To assure that RPT is appropriately implemented, advances in targeting need to be matched with advances in quantitative imaging and dosimetry methods. Currently, radiopharmaceutical therapy is administered by intravenous or locoregional injection, and the treatment planning has typically been implemented like chemotherapy, where the activity administered is either fixed or based on a patient’s body weight or body surface area. RPT pharmacokinetics are measurable by quantitative imaging and are known to vary across patients, both in tumors and normal tissues. Therefore, fixed or weight-based activity prescriptions are not currently optimized to deliver a cytotoxic dose to targets while remaining within the tolerance dose of organs at risk. Methods that provide dose estimates to individual patients rather than to reference geometries are needed to assess and adjust the injected RPT dose. Accurate doses to targets and organs at risk will benefit the individual patients and decrease uncertainties in clinical trials. Imaging can be used to measure activity distribution in vivo, and this information can be used to determine patient-specific treatment plans where the dose to the targets and organs at risk can be calculated. The development and adoption of imaging-based dosimetry methods is particularly beneficial in early clinical trials. In this work we discuss dosimetric accuracy needs in modern radiation oncology, uncertainties in the dosimetry in RPT, and best approaches for imaging and dosimetry of internal radionuclide therapy.

• OSTI ID: 23198630
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 109; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ABLATION
ACCURACY
CHEMOTHERAPY
CLINICAL TRIALS
DOSIMETRY
IN VIVO
IODINE 131
LIVER
LUTETIUM 177
METASTASES
NEOPLASMS
PATIENTS
RADIOPHARMACEUTICALS
RADIOTHERAPY
RADIUM 223
THYROID
YTTRIUM 90