台北荣核医部.ppt

Clinical applications of newer radionuclide therapies 台北榮總核醫部 王世楨 Radio-iodine was first used in the treatment of metastasized thyroid carcinoma in 1943. Its success in terms of tumour response, quality of life improvement and survival was considered a ‘miracle’, as in those days metastatic cancer was generally fatal. Inspired by this, many efforts have been made to apply radioisotope therapy to other tumours. One of the most important difference between targeted radionuclide therapy and external beam irradiation is the finite range of ionizing particles emitted. Targeted radionuclide therapy involves the use of radiolabeled tumor-seeking molecules to deliver a cytotoxic dose of radiation to tumor cells. Beta-particle emitters Alpha-particle emitters Auger electron Radionuclides that decay by the following three general categories of decay have been studied for therapeutic potential： Advantages of Targeted Radionuclide Therapy Tumor specific, with sparing of healthy tissue (low toxicity). No limit to the absorbed dose (no limit to the number of treatment). Radiation can be delivered to subclinical tumors and metastases that are too small to be imaged and thereby treated by surgical excision and external beam therapy. The European Association of Nuclear Medicine has issued guidelines on so-called ‘established’ therapies (), i.e. Hyperthyroidism Thyroid carcinoma Refractory synovitis Bone metastases MIBG therapy 32P therapy Lipiodol therapy Newer therapies include: Radio-peptide therapy Radio-immunotherapy of lymphoma Microsphere therapy for liver cancer Radiopeptide therapy Radiolabelled meta-iodobenzylguanidine (MIBG) A norepinephrine analog and false neurotransmitter?. Peptides specific to hormone receptors (mainly the somatostatin hormone analogue octreotide). Highly sensitive and specific for the detection of primary and secondary neuroendocrine tumours. This has led to their use as radiotherapeutic agents in neuro-endocrine tumours (NET