Radionuclide therapy is a systemic treatment that uses a molecule labelled with a radionuclide to deliver a high level of radiation to treat some cancers.
To determine if radionuclide therapy is suitable, a scan is first performed using the same molecule but labelled to a different type of radiation that is suitable for imaging rather than therapy. In this way, the therapy is personalised, making it possible to predict from the diagnostic scan which patients are likely to benefit from therapy. This type of therapy is also called theranostics, a principal of using the same molecule for both diagnosis and therapy. It enables doctors to visualise therapy, which is rare in cancer therapeutics.
Peter Mac was the first centre in Australia to perform this treatment for neuroendocrine tumours back in 1996 and has since pioneered some of the treatments that are now being adopted in other centres around the world.
Type of cancers treated with radionuclide therapy
Neuroendocrine tumours (NETs)
Radionuclide therapy is used for treating neuroendocrine tumours that arise from the pancreas, bowel and lung. A molecule that targets a specific receptor on the cell surface called somatostatin is labelled with a radioactive particle to target these tumours. This is called peptide receptor radionuclide therapy (PRRT). The radioactive particle is either Lutetium-177 or Yttrium-90. Peter Mac has extensive experience in giving PRRT and has a large neuroendocrine multidisciplinary team that cares for all aspects of patients with NETs.
In addition, a number of rare tumours including pheochromocytoma, parangalioma and neuroblastoma can be treated with this approach. Another therapy called Iodine-131 MIBG may be used to treat this cancers.
Many prostate cancers, in particular those that have spread or become resistant to hormonal therapies, express a unique substance on their cell surface called prostate-specific membrane antigen (PSMA). An evolving therapy that is currently performed as part of clinical trials is Lutetium-177 PSMA (LuPSMA) to deliver high doses of targeted radiation to sites of prostate cancer while sparing most normal tissues. The Prostate Theranostics and Imaging (ProsTIC) centre of excellence is funded by a grant from the Prostate Cancer Foundation (PCF) and comprises a multi-disciplinary team including nuclear medicine, medical oncology, radiation oncology, urology and laboratory-based doctors and researches with a strong patient-centred philosophy.
Tumours that have spread to bone (most commonly prostate or breast cancer) can be treated using radioactive particles that are taken up in areas of high bone turnover. The radioactive particles available for this type of treatment include Radium-223 (Xofigo), Strontium-90 and Samarium-153 EDTMP.
Radioactive iodine (Iodine-131) has been used to treat thyroid cancer for almost 80 years. This is done to treat some patients after thyroidectomy to destroy any remaining cancer cells and prevent the thyroid cancer returning. It is also used to treat patients with metastatic thyroid cancer.
Radioimmunotherapy (RIT) is a cancer therapy that uses targeted radiotherapy delivered directly to lymphoma cells with a drug called a monoclonal antibody. For this treatment, an antibody called rituximab, which targets a particular antigen (CD20) on the cell surface of lymphocytes, is labelled to radioactive iodine (Iodine-131 rituximab) to treat lymphoma. Your haematologist will generally decide whether this therapy is suitable for you.
What to bring to your nuclear medicine appointment
For the initial consultation with the nuclear medicine specialist, please bring any information you have including prior scans, test results or correspondence from your doctors.
Administration of radionuclide therapy
Radionuclide therapy is performed as either a day case or inpatient, depending on the amount and type of radiation administered. The majority of Lutetium-177 and Yttrium-90 therapies are performed as an outpatient, whereas inpatient admission is required for Iodine-131 therapies. For inpatient therapies, the stay is usually between one and three nights.
Side effects of radionuclide therapy
The side effects are dependent on the type of therapy chosen for your tumour type. The therapy results in much higher levels of radiation delivery to tumours compared with normal tissues, and in most cases side effects are therefore minimal or mild. A range of adverse effects, however, are possible and will be discussed with you prior to therapy.
Determining suitability for radionuclide therapy
To determine whether you are suitable for radionuclide therapy you will first consult a nuclear medicine specialist at Peter Mac. The physician will review the results of all investigations to date and discuss whether you might benefit from this therapy.
ProsTIC at Peter Mac offers PSMA radioligand therapy available at no cost to patients. A referral from your specialist is required. This can be sent to [email protected] and [email protected]
For all other services: A referral from your specialist or general practitioner is required. Visit the referral page for more information.
Cancer Imaging level 5
Peter MacCallum Cancer Centre
305 Grattan Street
Melbourne, VIC 3000
Phone: (03) 8559 5510
Fax: (03) 8559 5519
- Prof. Stephen Stuckey
- Prof. Michael Hofman
- Ms. Michelle McDade
- A/Prof. Tim Akhurst
- Dr Grace Kong
- A/Prof. Aravind RaviKumar
To find our more about our cancer imaging team visit our experts page.