UCSF Radiology MI&T Experts Review Dosimetry in Radionuclide Therapy

A team of faculty and fellows from the Molecular Imaging and Therapeutics (MI&T) section at the UC San Francisco Department of Radiology and Biomedical Imaging recently wrote a review on dosimetry in radionuclide therapy for a high-impact journal.

Radionuclide therapy is a rapidly expanding cancer treatment method and type of radiation therapy in which a radionuclide (radioactive chemical) is linked to a cell-targeting molecule, such as a monoclonal antibody, and injected into the body. From there, the cell-targeting molecule binds to a specific target found on some cancer cells. It's often used to treat prostate cancer, thyroid cancer, metastatic neuroendocrine tumors (NETs) and other types of cancer because it may help kill targeted cancer cells while also limiting harm to normal cells.

In clinical practice, the application of radionuclide therapy relies on fixed or empirical dosing strategies. The application of dosimetry promises to improve patient outcomes by tailoring administered radionuclide therapy activities to each patient's unique tumor burden and uptake. Authors from the UCSF Departments of Radiology, Helen Diller Family Cancer Center, Radiation Oncology, Pharmaceutical Chemistry along with the Department of Radiology at Weill Cornell Medical Center and the Department of Nuclear Engineering at UC Berkeley were invited to write a review for Lancet Oncology.

"Writing this review allowed us to take the conversation about this topic out of the radiology and molecular imaging space and engage with the broader oncology community as a whole," says Courtney Lawhn Heath, MD, assistant professor in the MI&T section and the lead author of this review.

Corresponding author on the review was Robert Flavell, MD, PhD, chief of the MI&T section. Other authors from the department include Thomas Hope, MD and Youngho Seo, PhD, UCSF Radiology faculty, and Jaehoon Shin, MD, PhD, clinical fellow.

"We think this is significant because dosimetry has been considered a very niche nuclear medicine topic in the past, but thanks to advances in imaging and analytic software technology, it is poised to change the way that radionuclide therapies (such as Lu-177 DOTATATE or Lu-177 PSMA) are dosed in the future," says Dr. Lawhn-Heath.

Overall, the authors concluded that dosimetry shows great promise in the personalization of radionuclide therapy. However, to establish the true added benefit of dosimetry-based activity modulation in radionuclide therapy, increased incorporation of dosimetry into clinical trials is needed, along with standardized dosimetry calculation methods and clinical practice guidelines. Read the full review in Lancet Oncology for more details.

Juana Martinez, MD and Edward Fung, PhD from the Department of Radiology, Weill Cornell Medical Center also contributed to this work.