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Wallner PE, Yoo DC, Calais J, Escorcia FE, Mari Aparici C, Michalski J, Morris M, Morris ZS, Pryma D, Rabatic BM, Sharma N, Vapiwala N, Ghesani MV, Subramaniam RM, Small W, Schechter NR. ACR-ACNM-ARS-ASTRO-SNMMI Practice Parameter for the Performance of Therapy With Radiopharmaceuticals. Am J Clin Oncol 2024; 47:169-176. [PMID: 38131352 DOI: 10.1097/coc.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American College of Nuclear Medicine, the American Radium Society, the American Society for Radiation Oncology, and the Society of Nuclear Medicine and Molecular Imaging. The document is intended to serve as a resource for appropriately trained and licensed physicians who perform therapeutic procedures with unsealed sources, referred to in the document using the more inclusive terminology of radiopharmaceuticals, for which a written directive is required for authorized users under NRC 10 CFR 35.300. METHODS This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the American Radium Society. RESULTS This practice parameter addresses the overall role of the applicable physician-authorized user, Qualified Medical Physicist, and other specialized personnel involved in the delivery of radiopharmaceutical therapy. Therapeutic radiopharmaceuticals include those administered as elemental radioactive isotopes (radionuclides) or the radioactive element incorporated into a targeting molecule (ligand) by one or more chemical bonds. This document provides guidance regarding general principles of radionuclide therapies and indications of various alpha, beta, gamma, and mixed emission agents with references to several recent practice parameters on new and commonly performed radiopharmaceutical therapies. CONCLUSION This document addresses clinical circumstances, elements of available agents, and the qualifications and responsibilities of various members of the radiation care team, specifications of consultation and other clinical documentation, post-therapy follow-up, radiation safety precautions, elements of quality control and improvement programs, infection control, and patient education to ensure optimal patient care and safety when utilizing radiopharmaceuticals.
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Affiliation(s)
| | - Don C Yoo
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jeremie Calais
- University of California, Los Angeles (UCLA), Los Angeles
| | | | | | - Jeff Michalski
- Washington University School of Medicine, Saint Louis, MO
| | | | - Zachary S Morris
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daniel Pryma
- Department of Radiology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | | | | | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Chicago, IL
- Department of Radiation Oncology, Maguire Center, Maywood, IL
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Patel V, Burns M, Patel S, Grossman S, Wali R, Sassoon I, Pintus E, Henien M. The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 3: prostate cancer. Br Dent J 2022:10.1038/s41415-022-3928-0. [PMID: 35145242 DOI: 10.1038/s41415-022-3928-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
Introduction Metastatic prostate cancer (MPC) patients due to receive bone-targeting agents (BTAs) are expected to undertake a dental assessment before commencing. The aim of this study was to determine the dental status of this tumour group and understand the challenges the dental practitioner faces in attempting to achieve 'dental fitness'.Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic and analysed for MPC. Statistical analysis and observational data were used to compare patient and tumour demographics.Results A total of 111 patients were included in this cohort, with the majority of patients presenting with only bone metastases (BM) and no additional metastatic sites. On average, MPC patients presented with 19.3 teeth and were below the threshold for functional dentition. The 75-84-year-old age group had the worst horizontal bone loss score and subsequently lose six teeth over a decade (p = 0.001). In addition, all MPC tumour sub-categories showed favourable survival rates.Conclusion MPC patients have a high dental burden on presentation, likely associated with their age. Favourable survival prospects and the cumulation of BTAs and dental disease would suggest a heightened risk of medication-related osteonecrosis of the jaw in this group compared to many other tumour sites.
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Affiliation(s)
- Vinod Patel
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK.
| | - Megan Burns
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | - Sheelen Patel
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | | | - Rana Wali
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | - Isabel Sassoon
- Computer Science Department, Brunel University, London, Kingston Lane, Uxbridge, UB8 3PH, UK
| | - Elias Pintus
- Medical Oncology, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | - Marianne Henien
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
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Serretta V, Valerio MR, Costa R, Tripoli V, Murabito A, Princiotta A, Scalici Gesolfo C, Borsellino N, Verderame F, Gebbia V, Licari M, Sanfilippo C. Radium-223 treatment in castration resistant bone metastatic prostate cancer. Should be the primary tumor always treated? Urol Oncol 2019; 37:964-969. [PMID: 31601517 DOI: 10.1016/j.urolonc.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radium-223 (223Ra) improves symptoms and survival in patients with bone metastatic castration-resistant prostate cancer (mCRPC). STUDY AIM To evaluate the impact of a previous radical prostatectomy (RP) on the outcome of 223Ra therapy in mCRPC patients. The primary prostate tumor left untreated could progress during 223Ra treatment. MATERIALS AND METHODS mCRPC symptomatic patients treated with 223Ra were enrolled. Luteinizing Hormone-Releasing Hormone analogue was maintained. No other anticancer therapy was given. 223Ra was administered i.v. at the dose of 55 kBq/kg every 4 weeks for 6 cycles. Patients were stratified according to previous RP or not. Hematological toxicity was monitored. Statistical analysis of 223Ra discontinuations, progressions, and deaths were performed. RESULTS Forty-four patients were enrolled, 16 (36.4%) previously received RP, 5 (11.3%) prostate radiotherapy and 23 (52.3%) maintained the primary prostate tumor after local treatment. All patients presented only bone metastases, 24 patients (54.5%) had more than 20. Twenty-six (59.1%) patients were treated after first or second line systemic chemotherapy. Treatment interruptions occurred in 14 patients (50%) with prostate and in 4 (25%) without (P = 0.04). After a median follow-up of 18 months (6-30 months), 15 (53.6%), and 7 (43.7%) progressions (P = 0.34) and 13 and 1 (6.2%) deaths (P = 0.04) occurred in patients with and without prostate respectively. CONCLUSION The presence of the primary prostate tumor seems to play a detrimental role in mCRPC patients undergoing 223Ra treatment in absence of other concomitant anticancer therapy. On the other hand a previous RP might play a protective role.
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Affiliation(s)
- Vincenzo Serretta
- Department of Surgical, Oncological and Oral Sciences, Urology Unit, University of Palermo, Italy; GSTU Foundation, Statistics, Palermo, Italy.
| | - Maria Rosaria Valerio
- Department of Surgical, Oncological and Oral Sciences, Medical Oncology Unit, University of Palermo, Italy
| | - Renato Costa
- Nuclear Medicine Unit, University of Palermo, Italy
| | | | | | - Alessandro Princiotta
- Department of Surgical, Oncological and Oral Sciences, Urology Unit, University of Palermo, Italy
| | - Cristina Scalici Gesolfo
- Department of Surgical, Oncological and Oral Sciences, Urology Unit, University of Palermo, Italy
| | - Nicolò Borsellino
- Oncology Unit, "Buccheri La Ferla Fatebenefratelli" Civic Hospital, Palermo, Italy
| | | | | | - Maria Licari
- Nuclear Medicine Unit, University of Palermo, Italy
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Kapoor A, Wong NC, Wang Y, Mukherjee S, Hotte S, Dayes I, Lukka H. Single-center experience with radium-223 in patients with castration-resistant prostate cancer and bone metastases. Asian J Androl 2019; 22:437-438. [PMID: 31535625 PMCID: PMC7406098 DOI: 10.4103/aja.aja_66_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON L8N 4A6, USA
| | - Nathan C Wong
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON L8N 4A6, USA
| | - Yuding Wang
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON L8N 4A6, USA
| | - Som Mukherjee
- Department of Oncology, McMaster University, Hamilton, ON L8N 4A6, USA
| | - Sebastien Hotte
- Department of Oncology, McMaster University, Hamilton, ON L8N 4A6, USA
| | - Ian Dayes
- Department of Oncology, McMaster University, Hamilton, ON L8N 4A6, USA
| | - Himu Lukka
- Department of Oncology, McMaster University, Hamilton, ON L8N 4A6, USA
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King R, Tanna N, Patel V. Medication-related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab-a review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:289-299. [PMID: 30713092 DOI: 10.1016/j.oooo.2018.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/22/2018] [Accepted: 11/23/2018] [Indexed: 01/23/2023]
Abstract
The link between medication-related osteonecrosis of the jaw (MRONJ) and bone modulating drugs, such as bisphosphonates and denosumab, is well established, and the number of reported cases is increasing. The development of novel medications used in the treatment of cancer, as well as autoimmune and bone conditions, has led to more cases of MRONJ being reported. However, in addition to this group of medications, increasing numbers of new agents in cancer therapy, such as antiangiogenic agents, have also been implicated in the development of MRONJ. As these newer agents with similar mechanisms are routinely used, the numbers of reported cases will likely rise further. This article aims to identify and summarize the drugs implicated in MRONJ, besides bisphosphonates and denosumab. A wide range of medications classified as tyrosine kinase inhibitors, monoclonal antibodies, mammalian target of rapamycin inhibitors, radiopharmaceuticals, selective estrogen receptor modulators, and immunosuppressants have been implicated in MRONJ. It remains crucial that oral health care providers are aware of these new medications and their associated risks to manage their patients appropriately.
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Affiliation(s)
- Rebecca King
- DCT2 (Oral Surgery), Oral Surgery Department, Guys Dental Institute, Guys & St. Thomas NHS Foundation Trust, London, UK
| | - Nikki Tanna
- Consultant (Oral Surgery), Oral Surgery Department, Eastman Dental Hospital, London, UK
| | - Vinod Patel
- Consultant (Oral Surgery), Oral Surgery Department, Guys Dental Institute, Guys & St. Thomas NHS Foundation Trust, London, UK.
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Stéen EJL, Edem PE, Nørregaard K, Jørgensen JT, Shalgunov V, Kjaer A, Herth MM. Pretargeting in nuclear imaging and radionuclide therapy: Improving efficacy of theranostics and nanomedicines. Biomaterials 2018; 179:209-245. [PMID: 30007471 DOI: 10.1016/j.biomaterials.2018.06.021] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 01/18/2023]
Abstract
Pretargeted nuclear imaging and radiotherapy have recently attracted increasing attention for diagnosis and treatment of cancer with nanomedicines. This is because it conceptually offers better imaging contrast and therapeutic efficiency while reducing the dose to radiosensitive tissues compared to conventional strategies. In conventional imaging and radiotherapy, a directly radiolabeled nano-sized vector is administered and allowed to accumulate in the tumor, typically on a timescale of several days. In contrast, pretargeting is based on a two-step approach. First, a tumor-accumulating vector carrying a tag is administered followed by injection of a fast clearing radiolabeled agent that rapidly recognizes the tag of the tumor-bound vector in vivo. Therefore, pretargeting circumvents the use of long-lived radionuclides that is a necessity for sufficient tumor accumulation and target-to-background ratios using conventional approaches. In this review, we give an overview of recent advances in pretargeted imaging strategies. We will critically reflect on the advantages and disadvantages of current state-of-the-art conventional imaging approaches and compare them to pretargeted strategies. We will discuss the pretargeted imaging concept and the involved chemistry. Finally, we will discuss the steps forward in respect to clinical translation, and how pretargeted strategies could be applied to improve state-of-the-art radiotherapeutic approaches.
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Affiliation(s)
- E Johanna L Stéen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Patricia E Edem
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Kamilla Nørregaard
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Jesper T Jørgensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Vladimir Shalgunov
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Matthias M Herth
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Abstract
223Radium (223Ra) is the first alpha-emitting therapy proven effective in human cancer. Prospective randomized trials indicate that 223Ra, which concentrates after intravenous injection in areas of osteoblastic metastatic disease, can prolong survival in bone-dominant castrate resistant prostate cancer patients. Though radium isotopic therapy is conceptually critical to demonstrate that alpha emitters can be safe and effective, 223Ra has inherent limitations given its restriction to bone metastatic disease. To overcome this limitation, targeted alpha therapy (TAT) is now being actively evaluated in prostate cancer, and other neoplasms. Key to TAT in prostate tumors in current studies is the overexpression of prostate specific membrane antigen (PSMA), a folate hydrolase expressed on the cell surface of malignant adenocarcinomas of the prostate. Using PSMA targeting (small molecules or antibodies), alpha emitting agents such as 225Actinium (225Ac) or 213Bismuth (213Bi) can be delivered to PSMA expressing tumors regardless of their metastatic location. Initial results from TAT in prostate cancer are highly promising and rapid development of these agents is anticipated in the years ahead assuming adequacy of isotope availability and appropriate clinical trial design. TAT may be develop as an independent approach, or synergize with a variety of other approaches including external beam radiation, hormonal therapies, chemotherapies, various radiation sensitizers, DNA repair inhibitors, and/or immune modulators. Clinical investigation opportunities in this field will rapidly increase in the years ahead.
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Affiliation(s)
- Oliver Sartor
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Radiation Oncology, Division of Hematology/Oncology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Medicine, Division of Hematology/Oncology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Deepali Sharma
- Department of Radiation Oncology, Division of Hematology/Oncology, Tulane University School of Medicine, New Orleans, LA, USA
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Luna Pais H, Alho I, Vendrell I, Mansinho A, Costa L. Radionuclides in oncology clinical practice – review of the literature. Dalton Trans 2017; 46:14475-14487. [DOI: 10.1039/c7dt01929g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Radionuclide therapy is a promising type of targeted therapy for cancer and its use is becoming more common in several types of malignant tumors.
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Affiliation(s)
- Helena Luna Pais
- Medical Oncology Department
- Hospital de Santa Maria
- 1649-035 Lisbon
- Portugal
| | - Irina Alho
- Instituto de Medicina Molecular
- Faculdade de Medicina
- Universidade de Lisboa
- 1649-035 Lisbon
- Portugal
| | - Inês Vendrell
- Medical Oncology Department
- Hospital de Santa Maria
- 1649-035 Lisbon
- Portugal
| | - André Mansinho
- Medical Oncology Department
- Hospital de Santa Maria
- 1649-035 Lisbon
- Portugal
| | - Luís Costa
- Medical Oncology Department
- Hospital de Santa Maria
- 1649-035 Lisbon
- Portugal
- Instituto de Medicina Molecular
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Improving quality of life in patients with advanced cancer: Targeting metastatic bone pain. Eur J Cancer 2017; 71:80-94. [DOI: 10.1016/j.ejca.2016.10.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/22/2016] [Indexed: 12/17/2022]
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In Vivo Radionuclide Generators for Diagnostics and Therapy. Bioinorg Chem Appl 2016; 2016:6148357. [PMID: 28058040 PMCID: PMC5183759 DOI: 10.1155/2016/6148357] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022] Open
Abstract
In vivo radionuclide generators make complex combinations of physical and chemical properties available for medical diagnostics and therapy. Perhaps the best-known in vivo generator is 212Pb/212Bi, which takes advantage of the extended half-life of 212Pb to execute a targeted delivery of the therapeutic short-lived α-emitter 212Bi. Often, as in the case of 81Rb/81Kr, chemical changes resulting from the transmutation of the parent are relied upon for diagnostic value. In other instances such as with extended alpha decay chains, chemical changes may lead to unwanted consequences. This article reviews some common and not-so-common in vivo generators with the purpose of understanding their value in medicine and medical research. This is currently relevant in light of a recent push for alpha emitters in targeted therapies, which often come with extended decay chains.
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Radium-223 dichloride in clinical practice: a review. Eur J Nucl Med Mol Imaging 2016; 43:1896-909. [DOI: 10.1007/s00259-016-3386-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/29/2016] [Indexed: 02/06/2023]
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