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Radionuclide Metabolic Therapy Clinical Aspects, Dosimetry and Imaging

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EANM® Eu ne rope edici an Association of Nuclear M Publications · Brochures Radionuclide Metabolic Therapy Clinical Aspects, Dosimetry and Imaging A Technologist’s Guide Produced with the kind Support of Editors Peștean, Claudiu (Cluj – Napoca) Veloso Jéronimo, Vanessa (Loures) Hogg, Peter (Manchester) Contributors Berhane Menghis, Ruth (Liverpool) Mayes, Christopher (Liverpool) Bodet-Milin, Caroline (Nantes) Pallardy, Amandine (Nantes) Chiti, Arturo (Milan) Peștean, Claudiu (Cluj – Napoca) Cutler, Cathy S. (Missouri) Piciu, Doina (Cluj – Napoca) do Rosário Vieira, Maria (Lisbon) Rauscher, Aurore (Nantes) Faivre-Chauvet, Alain (Nantes) Silva, Nadine (Lisbon) Flux, Glenn (Sutton, Surrey) Sjögreen Gleisner, Katarina (Lund) Gorgan, Ana (Cluj – Napoca) Strigari, Lidia (Rome) Kraeber-Bodéré, Françoise (Nantes) Szczepura, Katy (Manchester) Larg, Maria Iulia (Cluj – Napoca) Testanera, Giorgio (Milan) Lowry, Brian A. (Liverpool) Vinjamuri, Sobhan (Liverpool) Lupu, Nicoleta (Cluj – Napoca) Williams, Jessica (Philadelphia) Mantel, Eleanor S. (Philadelphia) Contents Foreword 5 Introduction 6 Claudiu Peştean, Vanessa Veloso Jerónimo and Peter Hogg Acronyms 7 Section I 1. Principles in Radionuclide Therapy (*) 9 Eleanor S. Mantel and Jessica Williams 2. Biological Efects of Ionising Radiation 18 Katy Szczepura 3. Dosimetry in Molecular Radiotherapy 29 Katarina Sjögreen Gleisner, Lidia Strigari, Glenn Flux 4. Special Considerations in Radiation Protection: Minimising Exposure of Patients, Staf and Members of the Public 41 Claudiu Peştean and Maria Iulia Larg EANM Section II Preamble on a Multiprofessional Approach in Radionuclide Metabolic Therapy 54 Giorgio Testanera and Arturo Chiti 1. Radionuclide Therapy in Thyroid Carcinoma 61 Doina Piciu 2. Radionuclide Therapy in Benign Thyroid Disease 77 Doina Piciu 3. Radionuclide Therapy in Neuroendocrine Tumours 81 Ruth Berhane Menghis, Brian A. Lowry, Christopher Mayes and Sobhan Vinjamuri 4. Radionuclide Therapy in Hepatocellular Carcinoma 93 Nadine Silva and Maria do Rosário Vieira 5. Radioimmunotherapy in Lymphomas 105 Aurore Rauscher, Caroline Bodet-Milin, Amandine Pallardy, Alain Faivre-Chauvet, Françoise Kraeber-Bodéré 6. Radionuclide Therapy of Refractory Metastatic Bone Pain 112 Brian A. Lowry, Ruth B. Menghis, Christopher Mayes and Sobhan Vinjamuri 7. Radiosynovectomy 121 Christopher Mayes, Brian A. Lowry, Ruth Berhane Menghis and Sobhan Vinjamuri 8. Nursing Implications for Patients Undergoing Radionuclide Metabolic Therapy 129 Ana Gorgan, Nicoleta Lupu and Claudiu Peștean Section III 1. Future Perspectives in Radionuclide Therapy (*) 136 Cathy S. Cutler Imprint 153 printed matters. Eco-Label with the Austrian for in accordance Printed (*) Articles were written with the kind support of and in cooperation with: 3 Acknowledgements The editors would like to express sincere gratitude to the following people, because without their generous help this book would not have come to fruition: Reviewer: Lisa Bodei English language editing: Rick Mills Project management: Katharina Leissing 4 Foreword Nuclear Medicine is a composite discipline Following the successful PET-CT Tech Guide in which radionuclide therapy has a role of series, this book is the joint work of many growing importance, with an increasing im- professionals from diferent nations and pact on clinical practice. Advances in radio- ields of interest within Nuclear Medicine. pharmaceutical production and the imple- I want to really thank all those people who mentation of a multidisciplinary approach have contributed to this work as authors and in clinical medicine have propelled radio- reviewers, without whom the book would nuclide therapy methods and application not have been possible. I am proud to be towards personalised treatment, therapeutic able to welcome and thank our colleagues eicacy, patient comfort and radiation safety. from the SNM (Society of Nuclear Medicine, Technologists are key igures in this process, United States) for their high-quality contribu- since their competencies allow them to play tions. I also wish to extend particular grati- an important role in every step necessary for tude to the EANM Dosimetry and Therapy EANM successful treatment, from radiopharmaceu- Committee for their availability and expertise tical preparation to administration. They are in the required ields. Special thanks are due also the main actors in pre- and post-thera- to Claudiu Peştean, Vanessa Veloso Jerónimo peutic imaging. The current book is specii- and Professor Peter Hogg, for their incredible cally aimed at radiographers and technolo- enthusiasm and competence in dealing with gists working in, or intending to work in, a the editorial duties and organisational work. Nuclear Medicine department with radionu- Finally, I remain extremely grateful to the clide therapy facilities, though it is also likely EANM Executive Committee, the EANM Exec- to be valuable for other healthcare profes- utive Secretariat, the Technologist Commit- sionals working in, or willing to work in, this tee and all the EANM committees involved in challenging environment. the project. A successful radionuclide therapy unit is not With my warmest regards only fundamental for patient care in Oncol- ogy, Endocrinology and Orthopaedics, but Giorgio Testanera can also serve as a gold standard in an inter- Chair, EANM Technologist Committee professional and multidisciplinary approach to clinical medicine. 5 Introduction Claudiu Peştean, Vanessa Veloso Jerónimo and Peter Hogg This year we have focussed on radionuclide the pathologies which it can treat and/or therapy for our book. For decades, radionu- where it can be used for palliation. This sec- clide therapy has been used to help manage tion contains signiicant input from those a range of malignant and benign diseases, who practice radionuclide therapy, especially and for many pathologies its utility is well nuclear medicine physicians and others who known and well documented. In the early have a range of relevant clinical skills. In Sec- years the radionuclide range and the pathol- tion III we consider the future, and particular ogies which could be managed (treatment emphasis is placed on molecular therapy. and/or palliation) were limited. However, The inal chapter considers new radionu- signiicant progress continues to be made, clides which may become valuable in the and there has been considerable expansion future. in the available therapeutic radionuclides and the pathologies which can be managed We should like to thank the authors who by them. On this basis we feel it is timely for have taken the time to write the chapters this book to be published. The book brings and also the reviewers who have provided together experts in the ield of radionuclide constructive feedback to the authors. We therapy from Europe and America in order acknowledge that writing and reviewing that they can share their theoretical knowl- involves a considerable efort and we hope edge and clinical/practical experience. These that the readers will ind this book useful for experts emanate from a range of professional training and practical purposes. backgrounds and include medical physicists, nuclear medicine physicians, radiographers, nuclear medicine technologists and others. The book commences with background information about radionuclide therapy (Section I). If you are new to radionuclide therapy, then we suggest that special atten- tion is paid to the irst four chapters as the information covered will give you a good theoretical grounding; with this in mind you can progress to read about the clinical and technical aspects of radionuclide therapy in Section II. Here, attention is paid to how to conduct radiotherapy procedures and also 6 Acronyms AFP Alpha-fetoprotein EBRT external beam radiotherapy American Joint Committee on Eastern Cooperative Oncology AJCC ECOG Cancer Group ALARA as low as reasonably achievable ETA European Thyroid Association Alpharadin® in Symptomatic ALYSMPCA FBC full blood count Prostate Cancer clinical trial FIT irst-line indolent trial Anti-TPO anti-thyroid peroxidase antibodies FL folicular lymphoma ATA American Thyroid Association FNAB ine-needle aspiration biopsy AuNPs gold nanoparticles FPMs ine postmitotic cells BED biologically efective dose FT free T BRAF human gene precursor of B-Raf 3 3 EANM gene protein FT4 free T4 BRMs biological response modiiers FTC follicular thyroid cancers BSA body surface area GFR glomerular iltration rate BT brachytherapy HAMA human anti-murine antibody CCK cholecystokinin HBV hepatitis B virus CD20 B-lymphocyte antigen HCC hepatocellular carcinoma COX cyclo-oxygenase HCV hepatitis C virus CPPD calcium pyrophosphate dihydrate HEGP high-energy general-purpose CR complete response HR homologous recombination International Atomic Energy CT Computed Tomography IAEA Agency disseminated intravascular DIC International Commission on coagulation ICRP Radiological Protection DIMs diferentiating intermitotic cells International Commission on ICRU DLBCL difuse large B-cell lymphoma Radiation Units and Measurements disease-modifying anti-rheumatic ITLC instant thin-layer chromatography DMARDS drugs LET linear energy transfer DNA deoxyribonucleic acid LQM linear quadratic model DSB double-strand break LSF lung shunt fraction DTC diferentiated thyroid carcinoma LT levothyroxine European Association of Nuclear 4 EANM Medicine MAbs monoclonal antibodies 7 multipotential connective tissue MCTs ROIs regions of interest cells RPMs reverting postmitotic cells MIBG metaiodobenzylguanidine
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