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Internal radiation therapy: a neglected aspect of nuclear medicine in the molecular era.

Lin Y - J Biomed Res (2015)

Bottom Line: With increasing evidence, internal radiation therapy, also known as brachytherapy, has become a neglected aspect of nuclear medicine in the molecular era.Relevant differences and status of their applications in China were mentioned as well.These molecular mediated internal radiation therapies are gaining increasing importance by providing palliative and curative treatments for an increasing number of diseases and becoming one of the important parts of molecular nuclear medicine.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Peking Union Medical College Hospital , Beijing 100730 , China .

ABSTRACT
With increasing evidence, internal radiation therapy, also known as brachytherapy, has become a neglected aspect of nuclear medicine in the molecular era. In this paper, recent developments regarding internal radiation therapy, including developments in radioiodine-131 ((131)I) and thyroid, radioimmunotherapy (RIT) for non-Hodgkin lymphoma (NHL), and radiopharmaceuticals for bone metastases. Relevant differences and status of their applications in China were mentioned as well. These molecular mediated internal radiation therapies are gaining increasing importance by providing palliative and curative treatments for an increasing number of diseases and becoming one of the important parts of molecular nuclear medicine.

No MeSH data available.


Related in: MedlinePlus

Whole-body maximum intensity projection images of a patient with a BRAF mutant papillary thyroid cancer.New iodine uptake is shown in nearly all previously negative lung and neck metastases. Panel A shows whole-body maximum-intensity projection images of a patient with a BRAF-mutant papillary thyroid cancer. New iodine uptake is shown in nearly all previously negative lung and neck metastases. Panel B shows fused axial PET-CT images of a patient with an NRAS-mutant, poorly differentiated thyroid cancer. Both new and significantly increased iodine uptake in lung metastases is shown. Cited from Ho AL et al. N Engl J Med, 2013, 368(7):623-632 with permission.
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f04: Whole-body maximum intensity projection images of a patient with a BRAF mutant papillary thyroid cancer.New iodine uptake is shown in nearly all previously negative lung and neck metastases. Panel A shows whole-body maximum-intensity projection images of a patient with a BRAF-mutant papillary thyroid cancer. New iodine uptake is shown in nearly all previously negative lung and neck metastases. Panel B shows fused axial PET-CT images of a patient with an NRAS-mutant, poorly differentiated thyroid cancer. Both new and significantly increased iodine uptake in lung metastases is shown. Cited from Ho AL et al. N Engl J Med, 2013, 368(7):623-632 with permission.

Mentions: Recently, selumetinib (AZD6244, ARRY-142886), a selective MEK 1 and MEK 2 inhibitor, has shown the ability to restore radioiodine incorporation RAI-refractory thyroid cancers in several clinical trials[31]. In one well-conducted clinical trial[31], selumetinib increased the uptake of iodine-124 in 12/20 patients (4/9 patients with BRAF mutations and 5/5 patients with NRAS mutations) (Fig. 4). Of the 12 patients who restored uptake of RAI, 8/12 patients reached the dosimetric threshold for radioiodine therapy, including all 5 patients with NRAS mutations. This study provides a proof of principle that MEK inhibitors can induce iodine uptake and retention in thyroid tumors. In another phase II study of selumetinib[32], patients with BRAFV600E mutation (12 of 26 evaluated, 46%) had an obviously longer median progression-free survival (PFS) compared with patients with BRAF wildtype tumors (33 vs. 11 weeks, respectively). These two studies suggest that selumetinib may have more effectiveness in the case of BRAFV600E or RAS mutation. A randomized, double-blinded study to compare the complete remission rate following a 5-week course of selumetinib or placebo and single dose adjuvant radioactive iodine therapy is ongoing. Although it remains a challenge to manage RAI-refractory advanced or metastatic thyroid cancer, re-differentiation agents may serve as a potential regimen for such patients. We suppose that a combination regimen of MAPK kinase inhibitors and other agents on a re-differentiation therapy with RAI may achieve more promising outcomes.


Internal radiation therapy: a neglected aspect of nuclear medicine in the molecular era.

Lin Y - J Biomed Res (2015)

Whole-body maximum intensity projection images of a patient with a BRAF mutant papillary thyroid cancer.New iodine uptake is shown in nearly all previously negative lung and neck metastases. Panel A shows whole-body maximum-intensity projection images of a patient with a BRAF-mutant papillary thyroid cancer. New iodine uptake is shown in nearly all previously negative lung and neck metastases. Panel B shows fused axial PET-CT images of a patient with an NRAS-mutant, poorly differentiated thyroid cancer. Both new and significantly increased iodine uptake in lung metastases is shown. Cited from Ho AL et al. N Engl J Med, 2013, 368(7):623-632 with permission.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4585428&req=5

f04: Whole-body maximum intensity projection images of a patient with a BRAF mutant papillary thyroid cancer.New iodine uptake is shown in nearly all previously negative lung and neck metastases. Panel A shows whole-body maximum-intensity projection images of a patient with a BRAF-mutant papillary thyroid cancer. New iodine uptake is shown in nearly all previously negative lung and neck metastases. Panel B shows fused axial PET-CT images of a patient with an NRAS-mutant, poorly differentiated thyroid cancer. Both new and significantly increased iodine uptake in lung metastases is shown. Cited from Ho AL et al. N Engl J Med, 2013, 368(7):623-632 with permission.
Mentions: Recently, selumetinib (AZD6244, ARRY-142886), a selective MEK 1 and MEK 2 inhibitor, has shown the ability to restore radioiodine incorporation RAI-refractory thyroid cancers in several clinical trials[31]. In one well-conducted clinical trial[31], selumetinib increased the uptake of iodine-124 in 12/20 patients (4/9 patients with BRAF mutations and 5/5 patients with NRAS mutations) (Fig. 4). Of the 12 patients who restored uptake of RAI, 8/12 patients reached the dosimetric threshold for radioiodine therapy, including all 5 patients with NRAS mutations. This study provides a proof of principle that MEK inhibitors can induce iodine uptake and retention in thyroid tumors. In another phase II study of selumetinib[32], patients with BRAFV600E mutation (12 of 26 evaluated, 46%) had an obviously longer median progression-free survival (PFS) compared with patients with BRAF wildtype tumors (33 vs. 11 weeks, respectively). These two studies suggest that selumetinib may have more effectiveness in the case of BRAFV600E or RAS mutation. A randomized, double-blinded study to compare the complete remission rate following a 5-week course of selumetinib or placebo and single dose adjuvant radioactive iodine therapy is ongoing. Although it remains a challenge to manage RAI-refractory advanced or metastatic thyroid cancer, re-differentiation agents may serve as a potential regimen for such patients. We suppose that a combination regimen of MAPK kinase inhibitors and other agents on a re-differentiation therapy with RAI may achieve more promising outcomes.

Bottom Line: With increasing evidence, internal radiation therapy, also known as brachytherapy, has become a neglected aspect of nuclear medicine in the molecular era.Relevant differences and status of their applications in China were mentioned as well.These molecular mediated internal radiation therapies are gaining increasing importance by providing palliative and curative treatments for an increasing number of diseases and becoming one of the important parts of molecular nuclear medicine.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Peking Union Medical College Hospital , Beijing 100730 , China .

ABSTRACT
With increasing evidence, internal radiation therapy, also known as brachytherapy, has become a neglected aspect of nuclear medicine in the molecular era. In this paper, recent developments regarding internal radiation therapy, including developments in radioiodine-131 ((131)I) and thyroid, radioimmunotherapy (RIT) for non-Hodgkin lymphoma (NHL), and radiopharmaceuticals for bone metastases. Relevant differences and status of their applications in China were mentioned as well. These molecular mediated internal radiation therapies are gaining increasing importance by providing palliative and curative treatments for an increasing number of diseases and becoming one of the important parts of molecular nuclear medicine.

No MeSH data available.


Related in: MedlinePlus