Current Status of Radiopharmaceutical Therapy.
Current Status of Radiopharmaceutical Therapy.
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DOI：
10.1016/j.ijrobp.2020.08.035
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发表时间：
2021-03-15
期刊：
影响因子：
--
通讯作者：
Xiao Y
中科院分区：
文献类型：
--
作者：
St James S;Bednarz B;Benedict S;Buchsbaum JC;Dewaraja Y;Frey E;Hobbs R;Grudzinski J;Roncali E;Sgouros G;Capala J;Xiao Y
在放射性药物治疗（RPT）中，放射性核素被全身或局部递送，目的是瞄准并向癌细胞传递辐射，同时最大限度地减少对非靶向细胞的辐射暴露。目前rpt的例子包括使用131I治疗甲状腺消融，使用90Y微球治疗肝癌，使用223Ra治疗骨转移，以及使用177Lu-DOTATATE治疗神经内分泌肿瘤。正在开发新的rpt，将放射性核素纳入系统性靶向治疗。为了确保RPT得到适当实施，靶向治疗方面的进展需要与定量成像和剂量测定方法的进展相匹配。目前，放射性药物治疗是通过静脉注射或局部注射进行的，治疗计划通常像化疗一样实施，其中施用的活动要么是固定的，要么是基于患者的体重或体表面积（BSA）。RPT的药代动力学可以通过定量成像测量，并且已知在肿瘤和正常组织中不同患者的药代动力学不同。因此，固定的或基于体重的活性处方目前还没有优化到在将细胞毒性剂量传递给靶标的同时保持在危险器官的耐受剂量范围内。在评估和调整RPT注射剂量时，需要对个体患者提供剂量估计而不是参考几何形状的方法。准确的靶向和危险器官剂量将有利于个体患者，并减少临床试验的不确定性。成像可用于测量体内活动分布，这些信息可用于确定患者特定的治疗计划，其中可计算对目标和危险器官的剂量。基于成像的剂量测定方法的发展和采用在早期临床试验中特别有益。在这项工作中，我们讨论了现代放射肿瘤学的剂量学精度需求，RPT中剂量学的不确定性以及内放射性核素治疗成像和剂量学的最佳方法。
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 131I, treatment of liver cancer with 90Y microspheres, the treatment of bony metastases with 223Ra and the treatment of neuroendocrine tumors with 177Lu-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 (BSA). 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.
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DOI：
10.2967/jnumed.111.100123
发表时间：
2012-08
期刊：
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
影响因子：
--
作者：
Dewaraja YK;Frey EC;Sgouros G;Brill AB;Roberson P;Zanzonico PB;Ljungberg M
通讯作者：
Ljungberg M
影响因子：
5.7
作者：
DUTREIX, A
通讯作者：
DUTREIX, A
影响因子：
9.3
作者：
Elschot, Mattijs;Lam, Marnix G. E. H.;de Jong, Hugo W. A. M.
通讯作者：
de Jong, Hugo W. A. M.
影响因子：
--
作者：
Bolch, W. E.;Jokisch, D.;Petoussi-Henss, N.
通讯作者：
Petoussi-Henss, N.
影响因子：
9.3
作者：
Bolch, Wesley E.;Eckerman, Keith F.;Thomas, Stephen R.
通讯作者：
Thomas, Stephen R.