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Radionuclide therapy beyond radioiodine

Radionuklidtherapien jenseits von Jod-131

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Summary

For decades, Iodine-131 has been used for the treatment of patients with thyroid cancer. In recent years, increasingly, other radiopharmaceuticals are in clinical use in the treatment of various malignant diseases. Although in principle these therapies—as in all applications of radionuclides—special radiation protection measures are required, a separate nuclear medicine therapy department is not necessary in many cases due to the lower or lack of gamma radiation. In the following article, four different radionuclide therapies are more closely presented which are emerging in the last years. One of them is the “Peptide Receptor Radionuclide Therapy,” the so-called PRRT in which radiolabeled somatostatin (SST)-receptor(R) ligands are used in patients with neuroendocrine tumors. On the basis of radiolabeled antibodies against CD20-positive cells, the so-called radioimmunotherapy is used in the treatment of certain forms of malignant lymphoma. In primary or secondary liver tumors, the 90Y-labeled particles can be administered. Last but not the least, the palliative approach of bone-seeking radiopharmaceuticals is noted in patients with painful bone metastases.

Zusammenfassung

Seit Jahrzehnten wird Iod-131 in der Behandlung von Patienten mit Schilddrüsenkrebs verwendet. In den letzten Jahren finden zunehmend auch andere Radiopharmaka im klinischen Betrieb bei der Behandlung von verschiedenen malignen Erkrankungen Anwendung. Obgleich bei diesen Therapien grundsätzlich – wie bei sämtlichen Therapien mit offenen Radionukliden – spezielle Strahlenschutzvorkehrungen erforderlich sind, ist eine eigene nuklearmedizinische Therapiestation in vielen Fällen aufgrund der geringeren bzw. fehlenden Gammastrahlung im Unterschied zur Radiojodtherapie nicht notwendig. Im Folgenden werden vier verschiedene Radionuklidtherapien näher beleuchtet, die in den letzten Jahren zunehmend an Bedeutung gewonnen haben. Bei der sog. Radionuklidpeptidtherapie bekommen die Patienten einen radioaktiv markierten Rezeptorliganden appliziert, welcher an Somatostatin-Rezeptor-exprimierendes Gewebe in neuroendokrinen Tumoren bindet. Auf der Basis eines Antikörpers gegen CD20-positive Zellen wird die sog. Radioimmuntherapie in der Behandlung von bestimmten Formen eines malignen Lymphoms eingesetzt. Bei primären oder sekundären Lebertumoren können 90Y-markierte Partikel verwendet werden, welche direkt in das Zielgewebe appliziert werden. Desweiteren ist auch der palliative Ansatz von knochenaffinen Radiopharmaka zur Behandlung von Tumorschmerzen aufgrund von Knochenmetastasen zu erwähnen.

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  1. Department of Nuclear Medicine and Endocrinology, General Hospital of Linz, Krankenhausstrasse 9, 4021, Linz, Austria

    Michael Gabriel MD

  2. University Clinic of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Michael Gabriel MD

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Gabriel, M. Radionuclide therapy beyond radioiodine. Wien Med Wochenschr 162, 430–439 (2012). https://doi.org/10.1007/s10354-012-0128-6

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