Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
Phys Med. 2023 Oct;114:103154. doi: 10.1016/j.ejmp.2023.103154. Epub 2023 Oct 5.
Molecular radiotherapy is the use of systemically administered unsealed radioactive sources to treat cancer. Theragnostics is the term used to describe paired radiopharmaceuticals localising to a specific target, one optimised for imaging, the other for therapy. For many decades, molecular radiotherapy has developed empirically. Standard administered activity schedules have been used without the prior estimation of the resulting tumour radiation absorbed dose by theragnostic imaging, or its subsequent measurement by serial scanning. This pragmatic approach has benefited many patients, however others who should have benefited have failed to do so as the radiation absorbed dose in the tumour was suboptimal. The accurate prediction and measurement of tumour and organ at risk radiation absorbed doses allows treatment to be personalised, and offers the prospect of improved clinical outcomes. To deliver this for all molecular radiotherapy patients would require not only a significant financial investment in equipment and skilled personnel, but also a change in attitude of those who believe that simple - or simplistic - schedules are easier to deliver, and that accurate dosimetry is too much trouble. Further clinical studies are required to demonstrate beyond doubt that the advantages of individualised treatment planning outweigh the inconvenience, and that the expense is justified by enhanced results.
分子放疗是指使用全身给予的非密封放射性源来治疗癌症。治疗诊断学是指用于描述定位到特定靶标的配对放射性药物，一种药物优化用于成像，另一种用于治疗。几十年来，分子放疗一直在经验性地发展。标准的给药活度方案已被使用，而没有通过治疗诊断成像来预先估计由此产生的肿瘤辐射吸收剂量，或随后通过连续扫描进行测量。这种务实的方法使许多患者受益，然而，其他本应受益的患者却没有受益，因为肿瘤中的辐射吸收剂量并不理想。准确预测和测量肿瘤和危险器官的辐射吸收剂量可以使治疗个体化，并提供改善临床结果的前景。要为所有分子放疗患者提供这种治疗，不仅需要在设备和熟练人员方面进行大量的财务投资，还需要改变那些认为简单或过于简化的方案更容易实施，而准确的剂量学太麻烦的人的态度。还需要进一步的临床研究来毫无疑问地证明个体化治疗计划的优势超过了不便之处，并且通过增强结果证明费用是合理的。
