Radio-nuclide therapy as the word suggests involves the use of radioactive medicines for the treatment of various diseases. Though nuclear medicine predominantly involves diagnostic procedures like PET and SPECT scans, therapeutic nuclear medicine forms an important constituent of Nuclear Medicine speciality. Radionuclide therapy uses radiopharmaceuticals emitting alpha (α) or beta (β) particles, which target specific cancers, such as thyroid, prostate, lymphoma or bone metastases. They are administered inside the body from where they target specific tumour cells and kill them.
Radionuclide therapies have been used for the treatment of many diseases since last century. Radio-iodine (or Iodine-131) was used for the treatment of hyperthyroidism (Grave’s disease, Multi-nodular goitre) and thyroid cancers as early as 1940. Radio-iodine is still the most popular and effective treatment of these disorders. Multiple other radionuclide therapies like Phosphorous-32, Samarium-153, Strontium-89 are still in use for various clinical indications.
Currently, a lot of research is happening globally in the branch of therapeutic nuclear medicine. More and more therapeutic molecules are now commercially available across the world which has brought drastic improvement in tumour or cancer management. Radionuclide therapies are actually targeted therapies, which attack a specific target on tumour cells without affecting healthy cells in the body, thereby limiting side effects. Few of the therapeutic nuclear medicine options recently approved by regulatory agencies are:
Peptide-receptor radionuclide therapy (PRRT): Yttrium-90 (Y-90) & Lutetium-177 (Lu-177) labelled DOTATATE and DOTATOC radionuclide therapies were introduced in the last decade for the treatment of metastatic neuroendocrine tumors (NETs). These are highly specific molecules which bind to somatostatin receptor-expressing cells in these tumors. Once these molecules bind, the beta-emitting radionuclide kills the tumor cells. The PRRT is now widely used by oncologists across the world and have improved the overall survival in these patients.
PSMA radioligand therapy (PRLT): Lu-177 labelled prostate-specific membrane antigen (PSMA) ligand therapy is a newer option for progressive and metastatic prostate cancers. The radiolabeled molecule binds to prostate-specific membrane antigen expressed on prostate cancer cells. This therapy is currently used when all other therapeutic options have been exhausted. This treatment has brought significant improvement in overall survival rates and quality of life in these patients.
Trans-arterial radio-embolization (TARE): Yttrium-90 labelled microspheres particles are used for the treatment of Hepatocellular carcinoma (HCC) and liver metastases. The particles are injected in the hepatic artery by the interventional radiologist in Cath-lab. The treatment is complex, however, has remarkable response rates.
Alpha therapy: This therapy is latest to join the ranks. Basically alpha emitters like Radium-223, Actinium are used for this therapy which deposits high amounts of energies in tumor cells leading to their death. These alphas emitters are currently used for the treatment of metastatic prostate cancers.
Radio-nuclide therapies have become an important component of overall cancer care. They play a complementary role to other established cancer treatments including surgery, chemotherapy and radiotherapy.
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