Radionuclide therapy is at the junction of two progressive areas - nuclear medicine and radiation exposure. This is a unique modern technology that is used in several areas of clinical medicine, including endocrinology and oncology. How is radionuclide therapy performed? What is the method based on? Who can and should not receive such treatment? Where is this type of therapy practiced in Russia? All answers are in our article.
The essence of the method
Radionuclide therapy is used in various fields. This method helps in the treatment of metastases that form in the lungs, liver, kidneys, and prostate gland. In some forms of malignant tumors, this remains the only possible effective form of treatment. For example, with distant metastases, which are formed with differentiated thyroid cancer.
The essence of radionuclide therapy is the treatment of dangerous diseases based on the introduction into the patient's body of all kinds of pharmaceuticals that have a therapeutic effect. Accumulating in a pathological focus, for example, in metastasis, they begin to emit active radiation with a minimum range, which begins to destroy damaged tissue. As a result, it is possible to begin effective treatment of tumor diseases.
Radionuclide therapy has a number of obvious advantages. These include:
- Good tolerance of this procedure, even when the patient is weakened, is in poor condition.
- Selectivity of action aimed only at a pathological focus or tumor.
- The possibility of using in the treatment of seriously ill patients, which may be their last chance.
- Quite a short hospitalization time.
Foreign practice
Currently, in developed foreign countries, there is an established network of radionuclide therapy departments with varying degrees of power. In Russia, this method is also used, but not so actively, because domestic technologies are still significantly behind foreign technologies. For example, in our country so far there is only one department specializing in this type of therapy. It operates on the basis of the radiological scientific center of the Russian Academy of Medical Sciences, located in Obninsk in the Kaluga Region. To get help, patients have to make an appointment in advance, wait their turn for several months.
There are also several clinics in St. Petersburg and Moscow in which patients have the opportunity to receive radionuclide therapy in oncology with the introduction of strontium-89, however, only on an outpatient basis. Moreover, in oncology and in endocrinology, the treatment with radioactive iodine-131 is considered the most effective. It is not possible to conduct it on an outpatient basis. This requires mandatory hospitalization in a specialized department.
Experts note that now in Russia the population’s need for this method of treatment is satisfied by only three percent. At the same time, this high-tech assistance is not available to the vast majority of the country's inhabitants. In the near future, it is planned that the use of this method will become much more active. At the moment, it is necessary to note its widespread revival.
Method Features
The essence of radionuclide diagnostics and therapy is the use of radiopharmaceuticals directly injected into the patient's body. This occurs intravenously, orally, interstitially or intracavitary. Substances begin to act directly on pathological foci, which leads to a significant improvement in the patient's condition.
Targeted and selective exposure is the main advantage of this method. Targeted delivery of pharmaceuticals helps to form high absorbed doses in the foci with minimal damage to normal healthy tissues and minor side effects.
Oncology application
There are several types of radionuclide therapy in oncology. The most common in the fight against neoplasms is radioiodine therapy, which is used in the treatment of patients with differentiated thyroid cancer. In non-oncological practice, this method is used to treat patients with thyrotoxicosis.
Osteotropic compounds of a number of radionuclides are also used in palliative therapy for bone metastases. It has been proven to be highly effective even if the pain syndrome progresses against the background of treatment carried out earlier.
Recently, more and more successfully used radioimmunotherapy for malignant gliomas, tumors of the gastrointestinal tract and bladder. In the treatment of tumors that have somatostatin receptors, synthesized analogues are used. Also, this method is used in the treatment of rheumatic synovitis.
Thyroid cancer
Currently widespread radioiodine therapy plays an important role in the combined treatment of thyroid cancer. This is a non-alternative method for patients with a potentially high risk of relapse of tumors and distant metastases. Other types of treatment in this situation, as a rule, are ineffective.
The application of this method is possible with near-total or total removal of the thyroid gland and metastases. Thyroid radionuclide therapy has recently been shown to be highly effective. Radioiodine therapy is effective in follicular and papillary cancer. In this situation, the goals of treatment are as follows:
- Suppression and destruction of the growth of thyroid cancer metastases, including those that were not detected in diagnostic studies.
- Destruction and destruction of the remains of thyroid tumor tissue, which remains after the surgical stage of treatment.
- Detection of a substrate that synthesizes thyroglobulin. Its blood level in the future may serve as a tumor marker.
- Finding metastases, including those that were not detected at the stage of radiography.
Diagnostic techniques
In both therapy and diagnosis, the radionuclide method is very effective. During the diagnosis, radioactive isotopes are used, as well as the compounds labeled by them, for the recognition of certain diseases.
Studies using this method have begun relatively recently. The physical foundations of radionuclide diagnostics and therapy were first formulated only in 1934, when artificial radioactivity was discovered. It was she who determined the possibility of obtaining isotopes and their compounds.
Treatment principles
At the heart of radionuclide diagnostics and therapy, physical radionuclides are used to assess the degree of dilution of a radioactive drug in body fluids.
Of great importance is the determination of changes in the level of radioactivity in systems and organs that occur over time, as well as in the focus of the disease itself. Specialists carefully study peripheral and central hemodynamics, renography, hepatography, determine the intra-thyroid stage of iodine metabolism, the dynamics of the level of phosphorus metabolism in the lesion.
Drug distribution
It is possible to diagnose the condition of the patient with maximum accuracy using the distribution of a radioactive drug introduced into his body. These are methods of gamma scintigraphy, scanning of organs and systems, including the thyroid gland, brain, liver, lungs, bone marrow, kidneys, bones, and lymphatic system.
The next step is to determine the rate of elimination of radioactive drugs from the body, as well as their redistribution in biological media.
Finally, the interaction of labeled compounds with the constituent parts of the body’s biological media should be evaluated. For example, in an antigen-antibody interaction.
Stages of development
For this diagnostic method, two main stages of development can be distinguished:
1. Beginner. It is associated with the development of research methods themselves. In particular, the development of programs to help find the most radioactive drugs, to establish which of them will most adequately reflect the state of the systems and organs of the human body. It is also important that the substances found create a minimal radioactive burden on the body of the subject. After development, the production and testing of special radio diagnostic equipment began. It included gamma cameras, tomographic scanners, multi-channel radiometers, and much more.
2. At the second stage, the main attention was paid to the profiling of radioisotope diagnostics, which was supposed to meet the needs of various clinical disciplines. For example, oncology, neurosurgery, cardiology, endocrinology, nephrology and many others. All this led to the creation of radioisotope diagnostics in a large number of specialized research centers.
Metastasis treatment
With the help of radionuclide therapy for metastases, using pharmaceuticals, an effective treatment of pain syndrome is carried out with widespread metastasis of cancer, when it begins to penetrate into bone tissue. With this method of treatment, the pharmaceutical product actively affects areas near metastases in which there is an increased metabolism.
When using the beta emitter of samarium, an effect occurs based on an increased metabolism during the penetration of phosphorus into the metastases of the skeleton. The drug actively affects the cells of the pathological focus. Moreover, the nerve endings surrounding it effectively suppress the pain syndrome.
Alpha emitter has an effect on bone tissue affected by metastases. In this case, the surrounding tissues that remain healthy, cause minimal damage. The treatment is intended to reduce pain, increase the life expectancy of the patient, increase bone strength. There is already successful treatment experience for cancer metastasized to the prostate gland.
Bone metastases
Radionuclide therapy with this pathology helps to get rid of the symptoms of a dangerous ailment, which are expressed in pain. This is one of the few effective methods of treatment, since this disease generally does not respond well to therapy due to numerous lesions, destruction of bone tissue, and progression of the growth of metastases.
Severe pain also torments patients with rheumatic problems. Currently, specialists use the domestic radiotherapeutic drug samarium, which is effective in the treatment of bone metastases even when a person has severe forms of rheumatic diseases.
Contraindications
Apply this method not for all patients. Contraindications include several factors. These include significantly reduced blood levels of leukocytes and platelets.
It is also important to pay attention to such significant contraindications:
- Severe coagulation.
- Deteriorating general condition with a survival prognosis of less than two months.
- The rapid development of extraosseous metastases, especially in the lungs, liver and brain.
- The threat of a pathological fracture, as well as compression of the spinal cord.
- The period of feeding the baby and pregnancy.
- Conducted myelosuppressive therapy (this method cannot be used simultaneously with radionuclide therapy).
All procedures should be performed according to a plan predefined by your doctor. It will consist of a single dissolution of the drug intravenously.
Patient opinions
In the reviews of radionuclide therapy, most patients note that their condition has improved significantly. According to the results of the therapy, they are sincerely grateful to the doctors and all medical personnel.
Patients immediately get hope for recovery when they are offered this type of therapy. At the next stage, it is possible to develop a plan for subsequent examinations and phased treatment. After a certain period, additional tests are appointed, after which you can already count on getting a quota from the Ministry of Health.