Nuclear medicine in the monitoring of organ function and the detection of injury related to cancer therapy.

This article emphasizes the role of nuclear medicine in the monitoring of function to prevent or limit injury in organs in which toxicity related to cancer therapy may have implications for the survival and/or the quality of life of the patient. After a brief discussion of the advantages of nuclear medicine techniques in detecting organ injury, the effect of radiation therapy and chemotherapy on normal tissue is discussed, underlining the need to characterize adverse effects of cancer therapy in long-term survivors. The use of radionuclides to document organ injury and effects from cancer therapy in heart, digestive tract, kidneys, lungs, major salivary glands, skeleton and brain is then reviewed. In a short section the potential applicability of positron emission tomography in documenting organ toxicity during cancer therapy is discussed. Thanks to the various available radiopharmaceuticals, the ability of the tracers to document specific functional aspects, the improved methods for visualization and quantitation of organ injury and the possibilities of physiological or pharmacological intervention, nuclear medicine gives the clinician potent tools for the monitoring of organ function at risk during cancer therapy. The trend to intensify cancer treatment by combining various treatment modalities and the increasing chances of prolonged survival in a large number of patients call for effective integration of nuclear medicine methods into the recommended guidelines for grading organ injury in clinical oncology.