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Nelson BJB, Wilson J, Andersson JD, Wuest F. Theranostic Imaging Surrogates for Targeted Alpha Therapy: Progress in Production, Purification, and Applications. Pharmaceuticals (Basel) 2023; 16:1622. [PMID: 38004486 PMCID: PMC10674391 DOI: 10.3390/ph16111622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
This article highlights recent developments of SPECT and PET diagnostic imaging surrogates for targeted alpha particle therapy (TAT) radiopharmaceuticals. It outlines the rationale for using imaging surrogates to improve diagnostic-scan accuracy and facilitate research, and the properties an imaging-surrogate candidate should possess. It evaluates the strengths and limitations of each potential imaging surrogate. Thirteen surrogates for TAT are explored: 133La, 132La, 134Ce/134La, and 226Ac for 225Ac TAT; 203Pb for 212Pb TAT; 131Ba for 223Ra and 224Ra TAT; 123I, 124I, 131I and 209At for 211At TAT; 134Ce/134La for 227Th TAT; and 155Tb and 152Tb for 149Tb TAT.
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Affiliation(s)
- Bryce J. B. Nelson
- Department of Oncology, University of Alberta, 11560 University Ave., Edmonton, AB T6G 1Z2, Canada; (B.J.B.N.); (J.W.); (J.D.A.)
| | - John Wilson
- Department of Oncology, University of Alberta, 11560 University Ave., Edmonton, AB T6G 1Z2, Canada; (B.J.B.N.); (J.W.); (J.D.A.)
| | - Jan D. Andersson
- Department of Oncology, University of Alberta, 11560 University Ave., Edmonton, AB T6G 1Z2, Canada; (B.J.B.N.); (J.W.); (J.D.A.)
- Edmonton Radiopharmaceutical Center, Alberta Health Services, 11560 University Ave., Edmonton, AB T6G 1Z2, Canada
| | - Frank Wuest
- Department of Oncology, University of Alberta, 11560 University Ave., Edmonton, AB T6G 1Z2, Canada; (B.J.B.N.); (J.W.); (J.D.A.)
- Cancer Research Institute of Northern Alberta, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Craig AJ, Taprogge J, Flux GD, Murray I. Radiation protection aspects for alpha therapies. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2023; 67:4-13. [PMID: 36633588 DOI: 10.23736/s1824-4785.22.03501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The use of alpha emitting radiotherapeutics is increasing, with further growth expected due to a number of clinical trials currently running involving new alpha emitters. However, literature concerning radiation safety aspects of alpha emitting radionuclides is limited and most of the available literature concerns 223Ra. In general, the occupational exposure from alpha emitting radionuclides is expected to be low, as are doses to the public from external exposure. However, care must be taken to avoid skin contamination, inhalation, and ingestion. Not all alpha emitting radionuclides are identical, they often have very different associated decay chains and emissions. The decay chains and the manufacturing process should be carefully examined to identify any long-lived progeny or impurities. These may have an impact on the radiation safety processes required to limit occupational exposure and for waste management. Doses to the public must also be assessed, either arising directly from exposure to patients treated with radiotherapeutics, or via waste streams. Risk assessments should be in place when starting a new service covering all aspects of the preparation and administration, as well as any foreseeable incidents such as skin contamination or patient death, and the appropriate steps to take in these instances. It is imperative that with the increase in the use of alpha emitting radiotherapeutics more literature is published on radiation safety aspects, especially for new alpha emitting radiotherapeutics which often have very different characteristics than the currently established ones.
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Affiliation(s)
- Allison J Craig
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, UK - .,The Institute of Cancer Research, London, UK -
| | - Jan Taprogge
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, UK.,The Institute of Cancer Research, London, UK
| | - Glenn D Flux
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, UK.,The Institute of Cancer Research, London, UK
| | - Iain Murray
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, UK.,The Institute of Cancer Research, London, UK
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Yang Y, Alencar LMR, Pijeira MSO, Batista BDS, França ARS, Rates ERD, Lima RC, Gemini-Piperni S, Santos-Oliveira R. [223Ra] RaCl2 nanomicelles showed potent effect against osteosarcoma: targeted alpha therapy in the nanotechnology era. Drug Deliv 2022; 29:186-191. [PMID: 35191342 PMCID: PMC8741223 DOI: 10.1080/10717544.2021.2005719] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Yang Yang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Martha Sahylí Ortega Pijeira
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Rio de Janeiro, Brazil
| | - Beatriz da Silva Batista
- Department of Physics, Laboratory of Biophysics and Nanosystems, Federal University of Maranhão, Maranhão, Brazil
| | - Alefe Roger Silva França
- Department of Physics, Laboratory of Biophysics and Nanosystems, Federal University of Maranhão, Maranhão, Brazil
| | - Erick Rafael Dias Rates
- Department of Physics, Laboratory of Biophysics and Nanosystems, Federal University of Maranhão, Maranhão, Brazil
| | - Ruana Cardoso Lima
- Department of Physics, Laboratory of Biophysics and Nanosystems, Federal University of Maranhão, Maranhão, Brazil
| | - Sara Gemini-Piperni
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ralph Santos-Oliveira
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Rio de Janeiro, Brazil
- Zona Oeste State University, Laboratory of Radiopharmacy and Nanoradiopharmaceuticals, Rio de Janeiro, Brazil
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4
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Watabe T, Kaneda-Nakashima K, Ooe K, Liu Y, Kurimoto K, Murai T, Shidahara Y, Okuma K, Takeuchi M, Nishide M, Toyoshima A, Shinohara A, Shirakami Y. Extended single-dose toxicity study of [ 211At]NaAt in mice for the first-in-human clinical trial of targeted alpha therapy for differentiated thyroid cancer. Ann Nucl Med 2021; 35:702-718. [PMID: 33871803 PMCID: PMC8134311 DOI: 10.1007/s12149-021-01612-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Astatine (211At) is a promising alpha emitter as an alternative to iodine (131I). We are preparing the first-in-human (FIH) clinical trial of targeted alpha therapy for differentiated thyroid cancer in consultation with Pharmaceuticals and Medical Devices Agency. Here, we performed an extended single-dose toxicity examination under a reliability standard, as a preclinical safety assessment of [211At]NaAt to determine the FIH dose. METHODS [211At]NaAt solution was injected into normal 6-week-old mice (male (n = 50) and female (n = 50), body weight: male 33.2 ± 1.7 g, female 27.3 ± 1.5 g), which were then divided into four groups: 5 MBq/kg (n = 20), 20 MBq/kg (n = 20), 50 MBq/kg (n = 30), saline control (n = 30). The mice were followed up for 5 days (primary evaluation point for acute toxicity: n = 80) or 14 days (n = 20: evaluation point for recovery) to monitor general condition and body weight change. At the end of the observation period, necropsy, blood test, organ weight measurement, and histopathological examination were performed. For body weight, blood test, and organ weight, statistical analyses were performed to compare data between the control and injected groups. RESULTS No abnormal findings were observed in the general condition of mice. In the 50 MBq/kg group, males (days 3 and 5) showed a significant decrease in body weight compared with the control. However, necropsy did not differ significantly beyond the range of spontaneous lesions. In the blood test, males (50 MBq/kg) and females (50 MBq/kg) showed a decrease in white blood cell and platelet counts on day 5, and recovery on day 14. In the testis, a considerable weight decrease was observed on day 14 (50 MBq/kg), and multinucleated giant cells were observed in all mice, indicating a significant change related to the administration of [211At]NaAt. CONCLUSIONS In the extended single-dose toxicity study of [211At]NaAt, administration of high doses resulted in weight loss, transient bone marrow suppression, and pathological changes in the testis, which require consideration in the FIH clinical trial.
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Affiliation(s)
- Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Institute for Radiation Sciences, Osaka University, Suita, Japan.
| | - Kazuko Kaneda-Nakashima
- Institute for Radiation Sciences, Osaka University, Suita, Japan
- Core for Medicine and Science Collaborative Research and Education, Project Research Center for Fundamental Sciences, Graduate School of Science, Osaka University, Toyonaka, Japan
| | - Kazuhiro Ooe
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Institute for Radiation Sciences, Osaka University, Suita, Japan
| | - Yuwei Liu
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenta Kurimoto
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Murai
- Bioscience Business Division, KAC Co., Ltd, Kyoto, Japan
| | - Yuka Shidahara
- Bioscience Business Division, KAC Co., Ltd, Kyoto, Japan
| | - Kenji Okuma
- Bioscience Business Division, KAC Co., Ltd, Kyoto, Japan
| | | | | | - Atsushi Toyoshima
- Institute for Radiation Sciences, Osaka University, Suita, Japan
- Core for Medicine and Science Collaborative Research and Education, Project Research Center for Fundamental Sciences, Graduate School of Science, Osaka University, Toyonaka, Japan
| | - Atsushi Shinohara
- Institute for Radiation Sciences, Osaka University, Suita, Japan
- Core for Medicine and Science Collaborative Research and Education, Project Research Center for Fundamental Sciences, Graduate School of Science, Osaka University, Toyonaka, Japan
- Department of Chemistry, Graduate School of Science, Osaka University, Toyonaka, Japan
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5
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Clinical Perspectives of Theranostics. Molecules 2021; 26:molecules26082232. [PMID: 33924345 PMCID: PMC8070270 DOI: 10.3390/molecules26082232] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
Theranostics is a precision medicine which integrates diagnostic nuclear medicine and radionuclide therapy for various cancers throughout body using suitable tracers and treatment that target specific biological pathways or receptors. This review covers traditional theranostics for thyroid cancer and pheochromocytoma with radioiodine compounds. In addition, recent theranostics of radioimmunotherapy for non-Hodgkin lymphoma, and treatment of bone metastasis using bone seeking radiopharmaceuticals are described. Furthermore, new radiopharmaceuticals for prostatic cancer and pancreatic cancer have been added. Of particular, F-18 Fluoro-2-Deoxyglucose (FDG) Positron Emission Tomography (PET) is often used for treatment monitoring and estimating patient outcome. A recent clinical study highlighted the ability of alpha-radiotherapy with high linear energy transfer (LET) to overcome treatment resistance to beta--particle therapy. Theranostics will become an ever-increasing part of clinical nuclear medicine.
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6
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Issa H, Serge ABM. Dosimetry of inhaled 219Rn progeny. JOURNAL OF RADIATION RESEARCH 2021; 62:226-235. [PMID: 33512484 PMCID: PMC8282910 DOI: 10.1093/jrr/rraa140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/19/2020] [Indexed: 06/12/2023]
Abstract
During prostate cancer treatment with 223Ra. 219Rn (actinon) occurs and may be exhaled by the patient. Nurses and other hospital employees may inhale this radionuclide and its decay products. The alpha-emitting decay products of actinon deposited within a body will irradiate tissues and organs. Therefore. it is necessary to evaluate organ doses of actinon progeny. The purpose of this study is to set up a dosimetric method to assess dose coefficients for actinon progeny. The effective dose coefficients were calculated separately for three modes. The unattached mode which concerned the activity median thermodynamic diameter (AMTD) of 1 nm. and the nucleation and accumulation modes which are represented by activity median aerodynamic diameters (AMAD) of 60 and 500 nm respectively. The recent biokinetic models of actinon progeny developed in the Occupational Intakes of Radionuclides (OIR) publications series of the International Commission of Radiological Protection (ICRP) were implemented on BIOKMOD (Biokinetic Modeling) to calculate the number of nuclear transformations per activity intake of actinon progeny. The organ equivalent and effective dose coefficients were determined using the dosimetric approach of the ICRP. The inhalation dose coefficients of actinon progeny are dominated by the contribution of lung dose. The calculated dose coefficients of 211Pb and 211Bi are 5.78 × 10-8 and 4.84 × 10-9 Sv.Bq-1 for unattached particles (AMTD = 1 nm). and 1.4 × 10-8 and 3.55 × 10-9 Sv.Bq-1 for attached particles (AMAD = 60 nm). and 7.37 × 10-9 and 1.91 × 10-9 Sv.Bq-1 for attached particles (AMAD = 500 nm). These values are much closer to those of the recently published ICRP 137.
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Affiliation(s)
- Hamadou Issa
- Nuclear Physics Laboratory. Faculty of Science. University of Yaoundé I. P.O. Box 812 Yaoundé. Cameroon
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7
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Wanke C, Pinkert J, Szermerski B, Geworski L. Assessment of the radiation exposure of relatives and caregivers of patients treated with Ra-223 - Results of a German multicenter study. Z Med Phys 2021; 31:58-64. [PMID: 33309149 DOI: 10.1016/j.zemedi.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/05/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
A multicenter study was conducted to assess the radiation exposure of relatives and caregivers of patients suffering from castration resistant prostate cancer with bone metastases and treated with Ra-223 dichloride in an outpatient setting. As Ra-223 and most of its progeny emit alpha particles, especially the internal exposure of persons in the patient's vicinity had to be evaluated. METHODS The external radiation was measured in distances of 1 m and 2 m. Wipe-tests were taken in the patients' homes to identify significant contaminations and evaluated by liquid scintillation counting. Samples of saliva and sweat were taken and measured using gamma spectrometry. RESULTS The external exposure from the patients measured 10-20min post injection (p. i.) was<0.080μSv/h in median in 1 m distance (range: below decision threshold ( CONCLUSIONS The potential exposure of relatives by external irradiation and incorporation of Ra-223 excreted by the patient with saliva or sweat is estimated to be well below 1 mSv. No objections are seen regarding outpatient treatment.
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Affiliation(s)
- Carsten Wanke
- Department for Radiation Protection and Medical Physics, Hannover Medical School, Hannover, Germany.
| | | | - Bastian Szermerski
- Department for Radiation Protection and Medical Physics, Hannover Medical School, Hannover, Germany
| | - Lilli Geworski
- Department for Radiation Protection and Medical Physics, Hannover Medical School, Hannover, Germany
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8
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Kaneda-Nakashima K, Zhang Z, Manabe Y, Shimoyama A, Kabayama K, Watabe T, Kanai Y, Ooe K, Toyoshima A, Shirakami Y, Yoshimura T, Fukuda M, Hatazawa J, Nakano T, Fukase K, Shinohara A. α-Emitting cancer therapy using 211 At-AAMT targeting LAT1. Cancer Sci 2021; 112:1132-1140. [PMID: 33277750 PMCID: PMC7935802 DOI: 10.1111/cas.14761] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
α-Methyl-l-tyrosine (AMT) has a high affinity for the cancer-specific l-type amino acid transporter 1 (LAT1). Therefore, we established an anti-cancer therapy, with 211 At-labeled α-methyl-l-tyrosine (211 At-AAMT) as a carrier of 211 At into tumors. 211 At-AAMT had high affinity for LAT1, inhibited tumor cell growth, and induced DNA double-stranded breaks in vitro. We evaluated the accumulation of 211 At-AAMT in vivo and the role of LAT1. Treatment with 0.4 MBq/mouse 211 At-AAMT inhibited tumor growth in the PANC-1 tumor model and 1 MBq/mouse 211 At-AAMT inhibited metastasis in the lung of the B16F10 metastasis model. Our results suggested that 211 At would be useful for anti-cancer therapy and that LAT1 is suitable as a target for radionuclide therapy.
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Affiliation(s)
- Kazuko Kaneda-Nakashima
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan
| | - ZiJian Zhang
- MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan.,Laboratory for Natural Product Chemistry, Department of Chemistry, Graduate School of Science, Osaka University, Osaka, Japan
| | - Yoshiyuki Manabe
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan.,Laboratory for Natural Product Chemistry, Department of Chemistry, Graduate School of Science, Osaka University, Osaka, Japan
| | - Atsushi Shimoyama
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan.,Laboratory for Natural Product Chemistry, Department of Chemistry, Graduate School of Science, Osaka University, Osaka, Japan
| | - Kazuya Kabayama
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan.,Laboratory for Natural Product Chemistry, Department of Chemistry, Graduate School of Science, Osaka University, Osaka, Japan
| | - Tadashi Watabe
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshikatsu Kanai
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,Department of Bio-System Pharmacology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuhiro Ooe
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsushi Toyoshima
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan
| | - Yoshifumi Shirakami
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan.,Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takashi Yoshimura
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,Radioisotope Research Center, Institute for Radiation Sciences, Osaka University, Osaka, Japan
| | - Mitsuhiro Fukuda
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,Research Center for Nuclear Physics, Osaka University, Osaka, Japan
| | - Jun Hatazawa
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takashi Nakano
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,Research Center for Nuclear Physics, Osaka University, Osaka, Japan
| | - Koichi Fukase
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan.,Laboratory for Natural Product Chemistry, Department of Chemistry, Graduate School of Science, Osaka University, Osaka, Japan
| | - Atsushi Shinohara
- Division of Science, Institute for Radiation Sciences, Osaka University, Osaka, Japan.,MS-CORE, PRC, Graduate School of Science, Osaka University, Osaka, Japan.,Laboratory for Radiochemistry, Department of Chemistry, Graduate School of Science, Osaka University, Osaka, Japan
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Gelardi F, Kirienko M, Sollini M. Climbing the steps of the evidence-based medicine pyramid: highlights from Annals of Nuclear Medicine 2019. Eur J Nucl Med Mol Imaging 2020; 48:1293-1301. [PMID: 33150459 DOI: 10.1007/s00259-020-05073-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
We aimed to provide an overview on research path in nuclear medicine climbing the steps of the Evidence-Based Medicine (EBM) pyramid using review of 14 subjectively selected papers out of 111 published in the Annals of Nuclear Medicine during January-December 2019. Following the structure of the EBM hierarchy, we chose at least one study for each step of the pyramid from the basis (pre-clinical research, expert opinion, case report and case series), to the middle (case-control and cohort studies, randomised controlled trials), towards the top (meta-analyses and systematic reviews). Additionally, we collected information on the promoter of each included study: investigator-initiated trials (IITs) vs industry-sponsored trials (ISTs). We found that pre-clinical studies are primarily focused on the development of novel molecular targets in cancer, with promising results. At the same time, clinical investigations deal with cardiological, neurological, infectious and oncological applications using both SPECT and PET modalities. Additionally, radionuclide therapy gained interest and is experiencing comprehensive clinical implementation. Our overview confirms the current central role of IITs as compared with ISTs. Challenges and future directions in Nuclear Medicine research are discussed.
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Affiliation(s)
- Fabrizia Gelardi
- Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Margarita Kirienko
- Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Martina Sollini
- Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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10
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A randomized, double-blind, comparison of radium-223 and placebo, in combination with abiraterone acetate and prednisolone, in castration-resistant metastatic prostate cancer: subgroup analysis of Japanese patients in the ERA 223 study. Int J Clin Oncol 2019; 25:720-731. [DOI: 10.1007/s10147-019-01589-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/24/2019] [Indexed: 01/08/2023]
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Hosono M, Ikebuchi H, Kinuya S, Yanagida S, Nakamura Y, Yamada T, Sakaguchi K, Sugano H, Kojima K, Hatazawa J. Manual on the proper use of yttrium-90-labeled anti-P-cadherin antibody injection for radionuclide therapy in clinical trials. Ann Nucl Med 2019; 33:787-805. [PMID: 31606788 PMCID: PMC6823325 DOI: 10.1007/s12149-019-01409-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 11/16/2022]
Abstract
We present the guideline for use of yttrium-90-labeled anti-P-cadherin antibody injection for radionuclide therapy in clinical trials on the basis of radiation safety issues in Japan. This guideline was prepared by a study supported by the Ministry of Health, Labour, and Welfare, and approved by the Japanese Society of Nuclear Medicine. Treatment using yttrium-90-labeled anti-P-cadherin antibody injection in Japan should be carried out according to this guideline. Although this guideline is applied in Japan, the issues for radiation protection shown here are considered internationally useful as well. Only the original Japanese version is the formal document.
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Affiliation(s)
- Makoto Hosono
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | | | - Seigo Kinuya
- Japanese Society of Nuclear Medicine, Tokyo, Japan
| | | | | | - Takahiro Yamada
- Atomic Energy Research Institute, Kindai University, Higashi-Osaka, Japan
| | - Kenta Sakaguchi
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | | | | | - Jun Hatazawa
- Japanese Society of Nuclear Medicine, Tokyo, Japan
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12
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Ooe K, Watabe T, Kamiya T, Yoshimura T, Hosono M, Shinohara A, Hatazawa J. Quantitative measurement of 219Rn radioactivity in exhaled breath from patients with bone metastasis of castration-resistant prostate cancer treated with 223RaCl 2. EJNMMI Phys 2019; 6:13. [PMID: 31350633 PMCID: PMC6660527 DOI: 10.1186/s40658-019-0249-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/10/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The α-emitting radionuclide radium-223 (223Ra) is widely used for the treatment of bone metastasis in patients with castration-resistant prostate cancer. However, 223Ra decays into radon-219 (219Rn) which is a noble-gas isotope, and 219Rn may escape from patients treated with 223Ra via their respiration. In this study, we quantified the amount of 219Rn contained in the breath of patients treated with 223Ra to estimate its effect on the internal exposure dose of caregivers. METHODS A total of 12 breath samples were collected using a breath collection bag from a total of six patients treated with 223RaCl2. Approximately 300 mL of exhaled breath was collected in a breath bag at 1 min and at 5 min after the start of 223RaCl2 administration. The contents of each bag were measured using an HPGe detector, and the amount of 219Rn was quantified based on the detection of the γ peak of 211Bi, which is a descendant nuclide of 219Rn, persisting in the breath bag. The effective dose to caregivers arising from the inhalation of 219Rn was estimated by referring to the scenario for the calculation of release criteria established for 131I therapy in Japan. RESULTS A small peak for the 351-keV γ ray of 211Bi originating from the exhalation of 219Rn was observed. Using the observed γ peak of 211Bi, the average amounts of 219Rn per unit breath volume at 1 min and 5 min after the start of 223RaCl2 administration were calculated as 90 ± 56 Bq/mL and 28 ± 9 Bq/mL, respectively. The effective dose of 219Rn to caregivers was estimated to be 3.5 μSv per injection. CONCLUSIONS The amount of 219Rn in the exhaled breath of patients treated with 223RaCl2 was quantitatively calculated using breath collection bags. The internal radiation exposure of caregivers from 219Rn in the exhaled breath of patients treated with 223RaCl2 is relatively small.
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Affiliation(s)
- Kazuhiro Ooe
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
- Division of Science, Institute for Radiation Sciences, Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka, 560-0043 Japan
| | - Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
- Division of Science, Institute for Radiation Sciences, Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka, 560-0043 Japan
| | - Takashi Kamiya
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
- Division of Science, Institute for Radiation Sciences, Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka, 560-0043 Japan
- Division of Radiology, Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871 Japan
| | - Takashi Yoshimura
- Radioisotope Research Center, Institute for Radiation Sciences, Osaka University, 2-4 Yamadaoka, Suita, Osaka, 565-0871 Japan
| | - Makoto Hosono
- Institute of Advanced Clinical Medicine, Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511 Japan
| | - Atsushi Shinohara
- Department of Chemistry, Graduate School of Science, Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka, 560-0043 Japan
- Division of Education, Institute for Radiation Sciences, Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka, 560-0043 Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
- Division of Education, Institute for Radiation Sciences, Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka, 560-0043 Japan
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13
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Nishiyama Y, Kinuya S, Kato T, Kayano D, Sato S, Tashiro M, Tatsumi M, Hashimoto T, Baba S, Hirata K, Yoshimura M, Yoneyama H. Nuclear medicine practice in Japan: a report of the eighth nationwide survey in 2017. Ann Nucl Med 2019; 33:725-732. [PMID: 31236776 DOI: 10.1007/s12149-019-01382-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Subcommittee on Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every 5 years since 1982 to survey contemporary nuclear medicine practice and its changes over the years. METHODS The subcommittee sent questionnaires, including the number and category of examinations as well as the kind and dose of the radiopharmaceuticals during the 30 days of June 2017, to all nuclear medicine institutes. The total numbers for the year 2017 were then estimated. RESULTS A total of 1132 institutes responded to the survey, including 351 PET centers. The recovery rate was 90.6%. The number of gamma cameras installed was 1332 in total, with 7.0% decrease in 5 years. Dual-head cameras and hybrid SPECT/CT scanners accounted for 88.2 and 23.6%, respectively. The number of single-photon tracer studies in 2017 was 1.08 million which means a decrease in 5.7% in 5 years and 23.6% in 10 years. All but neurotransmitter system, sentinel lymph node, and liver scintigraphy decreased. Bone scintigraphy was a leading examination (32.3%), followed by myocardial scintigraphy (24.1%) and cerebral perfusion study (18.0%) in order. SPECT studies showed an increase from 47.2% to 63.5%. PET centers have also increased from 295 to 389, as compared to the last survey. The 112 PET centers have installed one or two in-house cyclotrons. PET studies showed 24.5% increase in 5 years, with oncology accounting for 88.9%. 18F-FDG accounted for 98.2% (630,570 examinations). PET examinations using 11C-methionine have decreased, with 2440 examinations in 2017. PET examinations using 13N-NH3 have been increasing, with 2363 examinations in 2017. The number of PET studies using 11C-PIB was 904. 131I-radioiodine targeted therapies showed an increase in 5 years (23.1%), including 4487 patients for thyroid cancer. Out-patient thyroid bed ablation therapy with 1,110 MBq of 131I accounted for 36.6% of cancer patients. The number of admission rooms increased from 135 to 157 in 5 years. The number of 223Ra targeted therapies for castration-resistant metastatic prostate cancer was 1194 patients. CONCLUSIONS Single-photon examinations showed a continuous tendency toward a decline in the survey. In contrast, the number of hybrid SPECT/CT scanner examinations has increased. PET/CT study and radionuclide targeted therapy have steadily increased.
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Affiliation(s)
- Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Seigo Kinuya
- Department of Nuclear Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Takashi Kato
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Daiki Kayano
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Shuhei Sato
- Department of Health Informatics, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Manabu Tashiro
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Mitsuaki Tatsumi
- Department of Radiology, Osaka University Hospital, Suita, Japan
| | - Teisuke Hashimoto
- Department of Radiology, School of Medicine, Dokkyo Medical University, Mibu-machi, Japan
| | - Shingo Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mana Yoshimura
- Department of Radiology, Tokyo Medical University, Shinjuku, Japan
| | - Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital, Kanazawa, Japan
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14
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Hosono M. Perspectives for Concepts of Individualized Radionuclide Therapy, Molecular Radiotherapy, and Theranostic Approaches. Nucl Med Mol Imaging 2019; 53:167-171. [PMID: 31231436 PMCID: PMC6554368 DOI: 10.1007/s13139-019-00586-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/29/2022] Open
Abstract
Radionuclide therapy (RNT) stands on the delivery of radiation to tumors or non-tumor target organs using radiopharmaceuticals that are designed to have specific affinity to targets. RNT is recently called molecular radiotherapy (MRT) by some advocators in order to emphasize its characteristics as radiotherapy and the relevance of dosimetry-guided optimization of treatment. Moreover, RNT requires relevant radiation protection standards because it employs unsealed radionuclides and gives therapeutic radiation doses in humans. On the basis of these radiation protection standards, the development and use of radiopharmaceuticals for combined application through diagnostics and therapeutics lead to theranostic approaches that will enhance the efficacy and safety of treatment by implementing dosimetry-based individualization.
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Affiliation(s)
- Makoto Hosono
- Institute of Advanced Clinical Medicine and Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511 Japan
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15
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Kinuya S. Activities for the Development of Targeted Radionuclide Therapy in Japan. Nucl Med Mol Imaging 2019; 53:35-37. [PMID: 30828398 DOI: 10.1007/s13139-018-0563-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 01/06/2023] Open
Abstract
Targeted radionuclide therapy (TRT) is unique because of its efficacy and its theranostic feature in the era of precision medicine. So far, introduction of new TRT has not been going well in Japan due to several reasons including strict regulations, shortage of facilities for TRT, and insufficient reimbursement for TRT in clinic. Japanese community had several strategies to develop TRT in these 10 years, including the establishment of the National Conference for Nuclear Medicine Theranostics in which physicians, scientists, patients, people supporting patients, and industrial people gather. To promote TRT with supports from the government, the preparatory committee for the establishment of Japan Foundation of Medical Isotope Development (JAFMID) was launched. I would like to call TRT "Precision Nuclear Medicine." When we can add genomic information here, we can put it to new stage of cancer therapy. It is time for us.
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Affiliation(s)
- Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
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