Taprogge Jan, Leek Francesca, Flux Glenn D
Joint Department of Physics, Royal Marsden NHS Foundation Trust, Sutton, UK -
The Institute of Cancer Research, London, UK -
Q J Nucl Med Mol Imaging. 2019 Sep;63(3):271-277. doi: 10.23736/S1824-4785.19.03202-3. Epub 2019 Jul 16.
The field of molecular radiotherapy is expanding rapidly, with the advent of many new radiotherapeutics for the treatment of common as well as for rare cancers. Treatment outcome is dependent on the absorbed doses delivered to target volumes and to healthy organs-at-risk, which are shown to vary widely from fixed administrations of activity. There have been significant developments in quantitative imaging and internal dosimetry in recent years, although clinical implementation of these methods has been slow in comparison with external beam radiotherapy, partly due to there being relatively few patients treated at single centers. Multicenter clinical trials are therefore essential to acquire the data required to ensure best practice and to develop the personalized treatment planning that this area is well suited to, due to the unrivalled opportunity to image the therapeutic drug in vivo. Initial preparation for such trials requires a significant effort in terms of resources and trial design. Imaging systems in participating centers must be characterized and set up for quantitative imaging to allow for collation of data. Data transfer for centralized processing is usually necessary but is hindered in some cases by data protection regulations and local logistics. Recent multicenter clinical trials involving radioiodine therapy have begun to establish the procedures necessary for quantitative SPECT imaging in a multicenter setting using standard and anthropomorphic phantoms. The establishment of national and international multicenter imaging and dosimetry networks will provide frameworks to develop and harmonize best practice with existing therapeutic procedures and to ensure rapid and optimized clinical implementation of new radiotherapeutics across all centers of excellence that offer molecular radiotherapy. This will promote networks and collaborations that can provide a sound basis for further developments and will ensure that nuclear medicine maintains a key role in future developments.
随着许多用于治疗常见癌症和罕见癌症的新型放射治疗药物的出现，分子放射治疗领域正在迅速扩展。治疗结果取决于给予靶区体积和健康危及器官的吸收剂量，而这些剂量在固定活度给药时显示出很大差异。近年来，定量成像和体内剂量测定有了重大进展，尽管与外照射放疗相比，这些方法的临床应用进展缓慢，部分原因是在单一中心接受治疗的患者相对较少。因此，多中心临床试验对于获取确保最佳实践所需的数据以及制定该领域非常适合的个性化治疗计划至关重要，因为在体内对治疗药物进行成像具有无与伦比的机会。此类试验的初步准备在资源和试验设计方面需要付出巨大努力。参与中心的成像系统必须进行特性描述并设置用于定量成像，以便进行数据整理。通常需要进行数据传输以便集中处理，但在某些情况下会受到数据保护法规和当地后勤的阻碍。最近涉及放射性碘治疗的多中心临床试验已开始在多中心环境中使用标准和拟人化体模建立定量SPECT成像所需的程序。建立国家和国际多中心成像和剂量测定网络将提供框架，以开发和协调现有治疗程序的最佳实践，并确保在所有提供分子放射治疗的卓越中心快速且优化地临床应用新的放射治疗药物。这将促进能够为进一步发展提供坚实基础的网络和合作，并确保核医学在未来发展中保持关键作用。
