Theranostics combines diagnosis and therapy of diseases, especially cancer, in a personalised approach to delivering treatment.
Both diagnostic molecular imaging and therapy use substances called radiopharmaceuticals. Radiopharmaceuticals consist of a radioactive isotope combined with a specific targeting agent, which seeks out specific clusters of cells in the body (for example certain types of cancer cells).
During diagnostic molecular imaging, the radiopharmaceutical contains a relatively low radiation dose radioisotope, combined with a targeting agent which is specially designed to find and highlight abnormal tissue, for example in PET/CT scanning. The images produced are used to localise and stage the extent of disease and allow personalised treatment planning.
In a therapeutic approach, the targeting agent seeks out the same abnormal tissue demonstrated on imaging; however, the radioactive isotope is exchanged for one that delivers a comparatively higher radiation dose. In this way, the radiopharmaceutical delivers a treatment dose of radiation to damage the diseased cells, while largely sparing adjacent healthy tissue.
Using a theranostics approach, pairs of radiopharmaceuticals can be used in a complementary way to both diagnose and treat disease in an individualised manner.
Types of nuclear medicine therapies
We offer Lutetium-177 PSMA therapy to patients with metastatic prostate cancer where treatment with hormone therapy and/or chemotherapy is no longer effective.
We offer Lutetium-177 DOTATATE therapy to patients with neuroendocrine tumours considered suitable for therapy.
We offer Iodine-131 therapy to patients with thyroid disease.
Other therapies may be available on discussion with your referring doctor or our nuclear medicine specialists.
Potential benefits and side effects of nuclear medicine therapy
The aim of nuclear medicine therapy when treating metastatic prostate cancer and neuroendocrine tumours is to reduce symptoms caused by the disease. Life expectancy could potentially be extended. Some patients experience a very favourable response to nuclear medicine therapy with significant shrinkage of tumours and remission of the disease. Other patients experience a lesser response to nuclear medicine therapy. It can be difficult to determine the potential response in individual patients before therapy has started.
Nuclear medicine therapy is generally well tolerated. The most common side effects are a dry mouth and dry eyes. These issues may improve over time or sometimes be permanent. Other common side effects include nausea, vomiting and fatigue. These side effects are typically mild and will resolve after a few days.
When receiving 177-Lutetium DOTATATE therapy for a functioning neuroendocrine tumour, the therapy may temporarily worsen tumour related symptoms whilst treatment is taking effect.
Rare serious side effects include suppression of bone marrow activity and damage to the kidneys. Our team will provide personalised discussion of the benefit and risks of therapy with you.
Accessing nuclear medicine therapy
- To undergo nuclear medicine therapy, you'll need a referral from your oncologist or endocrinologist. You can contact our bookings team on 039625700 or email [email protected]. Our team will help facilitate your appointment.
- You will be offered a consultation with one of our nuclear medicine specialists to determine if nuclear medicine therapy is appropriate for you and to set up a treatment plan.
- To best determine your treatment plan, additional PET-CT imaging and blood tests may be required.
- Inform your healthcare provider and our team of any medications you are taking.
- Please let our team know if you are or think you could be pregnant.
What to expect during nuclear medicine therapy
On the day of your therapy the nuclear medicine technologist will infuse the treatment radiopharmaceutical slowly using an automatic intravenous infusion pump. You are likely to be with us for some hours during the treatment. When receiving 177-Lutetium DOTATATE therapy, you will also be administered an infusion to protect your kidneys from side effects. You may also receive medication to reduce nausea. When receiving I-131 treatment for thyroid disease, you will instead be asked to swallow the treatment radiopharmaceutical in the form of a tablet.
It is a good idea to bring a book or magazine to help pass the time whilst receiving therapy.
When the therapy session is completed, you will receive information about how to minimise the risk of radiation exposure to your family and community.
The day following your therapy session, you will be asked to return to the clinic for a post treatment SPECT-CT scan. This scan is used to evaluate the uptake of the radiopharmaceutical in the tumours and to help guide your future treatments.
You will be offered follow-up blood tests and consultation with our team to monitor your treatment response.
Radiation exposure
Theranostics will inherently result in high radiation doses to patients due to the nature of the radiopharmaceutical treatment. Potential benefits of nuclear medicine therapy should always outweigh the risks of the necessary radiation exposure.
We follow strict international guidelines and monitor your post therapy scans to ensure the risk of damage to healthy tissue is kept to a minimum.