Smart Radiation Therapies: Radionuclide Therapies

As cancer, one of the most important diseases of our age, becomes increasingly common, new and more effective treatments are also on the agenda. One of the most important treatments is “Radionuclide Therapies”… In the Department of Nuclear Medicine, using radioactive substances marked with targeted radiation, patients diagnosed with prostate cancer and neuroendocrine tumors can be treated with the most modern treatment methods. Radiation administered to the patient intravenously and marked with a substance targeting the tumor tissue goes to all tumor cells in the body and destroys them. While this treatment works just like radiotherapy, it provides the opportunity to destroy the tumor from the inside with internal radiation. With this method, which is a targeted treatment, healthy cells in the body are not damaged; Not only does the patient’s quality of life not deteriorate, but their life expectancy is also extended. We can also call this treatment, which focuses on destroying only tumors without touching other healthy tissues and organs, “Smart radiation treatments”.

Anadolu Health Center Nuclear Medicine Specialist Assoc. Dr. Kezban Berberoğlu answered questions about radionuclide treatments…

What are radionuclide treatments?

“Radionuclide therapy” can be briefly defined as treatment with radiation-emitting substances. These treatments make a significant difference for patients in the treatment of diseases such as prostate cancer and neuroendocrine tumors. It offers patients an extra treatment method, unlike chemotherapy and radiotherapy.

Nuclear Medicine Specialist Assoc. Dr. Kezban Berberoğlu was the guest of the program “A New Day with Çağla”, which was broadcast live on FOX TV with the presentation of Çağla Şikel.

In the Department of Nuclear Medicine, we use radioactive substances for the diagnosis of diseases. These are radioactive substances such as technetium 99 m and fluorine18. We add organ-specific or application-specific substances to this radioactive part. For example, if we want to perform bone scintigraphy, we put a special agent in the bone, or if we want to image the tumor, we add a substance such as glucose that enters the tumor and shows its viability. Until now, what we have always talked about in nuclear medicine was FDG PET-CT marked with F18, that is, the studies we carried out with the substance fluorine18 bound to glucose. We use this substance in many types of cancer, it is a method that is routinely included in the guidelines. But of course, medical science is advancing and it has been seen that we cannot image some types of cancer well. For example, prostate cancer. In the studies conducted, we see that imaging with a prostate-specific substance labeled with Gallium 68 has become the gold standard today, with which we can visualize prostate cancer and show the diagnosis, staging and response to treatment of the disease. With the same logic, when we connected Gallium 68 with Dota, a substance specific to this tumor, in neuroendocrine tumors, which is another type of tumor for which the FDG PET/CT method is not very good, a very reliable imaging method emerged for these tumors. We can make a meaningful contribution to patients by using these methods in our routine practice in our clinic.

It is very important to image diseases with appropriate radioactive substances, because if we mark the disease we see with therapeutic radiation, we can treat it by giving targeted targeted radiation through the vascular access. In medicine, we call these imaging agents “theranostic” agents. This can be described as the beginning of a groundbreaking era in medicine. In other words, in diseases such as prostate cancer or neuroendocrine tumor, we can diagnose and stage the disease and show whether it responds to treatment, thanks to PET/CT studies performed with appropriate agents. Another important information that these theranostic agents give us is that they show us whether these diseases can be treated with specially marked radiation. By performing this imaging on the patient we will treat, we can see in advance whether the treatment we will provide will be beneficial or not. If we can see the lesions and distinguish cancer cells in the Gallium-68 PET-CT examination performed before the treatment, we understand that we will benefit from radionuclide treatments.

What agents do you have for treatment?

We have two radioactive substances for treatment. One is Lutetium-177 and the other is Actinium 225. Both can be used in cancer treatments. Actinium 225 delivers pure alpha energy to the tumor. Lutetium enters the tumor cell with its beta energy, and both radioactive substances cause damage to the DNA of the tumor cell, causing the death of the tumor cell. It is possible to evaluate this treatment method as “internal” radiotherapy. The best part of this treatment is that the radioactive substance only reaches the tumor and destroys it, and the damage to the surrounding tissues and organs is minimal. We can say that radionuclide treatments are smart and targeted treatments. People are discharged on the same day or the next day after these radiation treatments, and they do not give a significant amount of radiation to their environment.

Targeted, smart treatments, these are…

It definitely is. We can call it “targeted radionuclide therapy”. We can also call these “smart radiation treatments”.

When are these treatments used?

Radionuclide treatments are actually methods used when radiotherapy and chemotherapy treatments are not very effective. In fact, most of the time the treatments complement each other. In a multidisciplinary environment, that is, where many branches come together and receive support from each other, when the treatment should be applied is evaluated and determined by this team. In fact, the expression “last option treatment application” is not correct. The success of treatments applied at the appropriate time is higher. It is important that the entire team has the same sensitivity so that the patient does not miss this chance.

How common are radionuclide treatments?

Its prevalence is increasing as publications on the success of treatments increase. We see that the success of the treatment is higher in teams that are experienced and have a multidisciplinary work culture. Making patient-specific planning and following the patient appropriately increases the success of treatment.

Which patients are these treatments applied to?

These treatments are used in patients diagnosed with hormone-resistant metastatic prostate cancer and neuroendocrine tumors. Thanks to these treatments, we see that, for example, patients with metastatic prostate cancer who do not respond to treatment respond to treatment and their pain decreases. Since no side effects occur, they have a comfortable time during this period. This is a very important contribution, especially for elderly patients. It makes us all very happy to be able to take the patient away from treatments that are ineffective and develop side effects, to have a comfortable time and to be able to treat them. For example, we often experience the satisfaction of patients who come to their first cycle in a wheelchair and enter their second cycle on foot.

How many cycles of radionuclide treatments are administered?

The radiation dose we need to give to destroy all of the cancer is very high. We cannot do this all at once because when we give high doses of radiation, normal cells also die. Therefore, we apply these treatments every 2 months for 4-6 cures. We can make significant contributions to the treatment of these patients with this method, which provides our patients with a comfortable treatment process thanks to the low possibility of side effects during treatment and the good responses received to the treatment.