Radionuclide Therapy

What Is Radionuclide Therapy?

The concept of radionuclide therapy is based on discovering that the degenerated cells of certain types of tumors carry tissue-specific features on their surface that serve as targets for so-called radionuclides, i.e., radioactive atoms that accumulate in the tumor tissue thanks to precise navigation and irradiate the cancer cells very locally.

The radioactive substances are infiltrated into the tumor substance by the target cells themselves, like a Trojan horse. Although even the therapy was developed to treat malignant cancers, the method is also used to treat benign diseases.

The radiation radius of the radioactive elements used is in the micrometer range so that damage to other organs and the surrounding tissue can be reduced to a minimum.

For Which Diseases Is Radionuclide Therapy Used?

For some types of tumors, characteristic surface features could be identified, which makes the pharmaceutical design of new drugs possible in the first place.

With today's scientific knowledge, prostate cancer, neuroendocrine tumors, bone metastases, thyroid cancer, non-Hodgkin's lymphoma, and benign thyroid gland diseases or inflammatory diseases of the joints can be treated effectively.

Which Forms of Therapy Are Available?

The most commonly used forms of therapy are radioiodine therapy for treating thyroid diseases and radiosynoviorthesis for treating inflammatory joint disorders. The drug is injected directly into the affected joint space. Radiopharmaceuticals have also become established as a low side-effect treatment for skeletal pain caused by metastases in breast cancer and prostate cancer.

Procedure and Duration

The radioactive drug is applied into the body in an outpatient setting via vascular access and reaches the target cells with the bloodstream. An inpatient stay is usually not necessary. The "irradiation from within" destroys the cells concerned. Thus, metastatic pain can be effectively relieved with an onset of action within a few days. Before starting therapy, PET-CT is often carried out as radiological imaging to localize the metastases.

Risks and Side Effects

Due to the very localized radiation delivery to the target tissue, serious side effects rarely occur with this form of therapy. In addition, sparing of surrounding tissue structures also reduces the risk of radiation-induced degeneration of neighboring organs.

Rarely, temporary gastrointestinal discomfort occurs in the first few days after injection.

Since the drug is excreted via the kidneys, it is essential to check kidney function before starting therapy and to ensure adequate fluid intake after beginning treatment.

The only profound side effect described is bone marrow depression, i.e., a disturbance of those blood cells in the bone that serve blood clotting and immune defense. However, the hematopoietic cells in the bone marrow can usually recover from the impairment. Nevertheless, a stable blood count is an absolute prerequisite for the use of radionuclide therapy.

Costs and Reimbursement by Health Insurance Companies

The costs of radionuclide therapy for treating metastasis-related bone pain with the Product Xofigo are covered by statutory and private health insurance companies. In the case of other, newer procedures, an individual application for cost coverage may have to be submitted. In this application, the treating physician must justify the therapy decision to the payer.