Seminars in Nuclear Medicine RSS feed: Current Issue. Seminars in Nuclear Medicine is a timely source for new concepts and techniques in nuclear medicine. The clinically oriented articles provide a reference for those involved in the performance and interpretation of nuclear medicine procedures. The contributing authors represent many of the recognized authorities from around the world. Seminars in Nuclear Medicine has an impact factor of 5.083 and is ranked 6th of 90 journals in Radiology, Nuclear Medicine & Medical Imaging category on the 2009 Journal Citation Reports®, published by Thomson Reuters. 2009 Topics , Volume 39, Issues 1-6 January Infection, I March Infection, II May Pharmacologic Interventions and Monitoring July Hybrid Imaging September Bone Update, I November Bone Update, II http://www.seminarsinnuclearmedicine.com/?rss=yesElsevier Inc.en © 2009 Elsevier Inc. All rights reserved. Seminars in Nuclear Medicine0001-2998402March 2010 © 2009 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.seminarsinnuclearmedicine.com/article/PIIS0001299809001160/abstract?rss=yesDr Hans Biersack has put together a stellar group of investigators in this issue to review some of the important therapeutic radionuclide applications and to present some exciting recent developments.Letter from the EditorsLeonard M. Freeman, M. Donald Blaufox10.1053/j.semnuclmed.2009.12.003Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-37576http://www.seminarsinnuclearmedicine.com/article/PIIS0001299809001123/abstract?rss=yesNuclear medicine offers both diagnostic and therapeutic procedures. Up to 10 years ago, the therapeutic spectrum primarily covered benign and malignant thyroid diseases. Additionally, relatively few patients were treated with 89Sr for bone pain palliation or with radioactive colloids for malignant pleural or peritoneal metastatic spread. However, the last years have witnessed a proliferation of additional techniques that have enhanced our therapeutic capabilities. With the advent of Zevalin, 90Y DOTATOC, and selective internal radiation therapy (SIRT), the importance of nuclear medicine therapy has increased considerably. This issue of Seminars in Nuclear Medicine will summarize the progress and potential of therapeutic radioisotopes.Guest EditorialHans-Jürgen Biersack10.1053/j.semnuclmed.2009.11.003Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-37777http://www.seminarsinnuclearmedicine.com/article/PIIS0001299809001020/abstract?rss=yesSomatostatin receptor imaging with [111In-DTPA0)octreotide has proven its role in the diagnosis and staging of gastroenteropancreatic neuroendocrine tumors. Treatment with radiolabeled somatostatin analogues is a promising new tool in the management of patients with inoperable or metastasized, well-differentiated neuroendocrine tumors. Symptomatic improvement may occur with all 111In, 90Y, or 177Lu-labeled somatostatin analogues that have been used for peptide receptor radionuclide therapy. The results that were obtained with [90Y-DOTA0, Tyr3]octreotide and [177Lu-DOTA0, Tyr3]octreotate are very encouraging in terms of tumor regression. Also, if kidney protective agents are used, the side effects of this therapy are few and mild, and the median duration of the therapy response for these radiopharmaceuticals is 30 and 40 months, respectively. The patients' self-assessed quality of life increases significantly after treatment with [177Lu-DOTA0, Tyr3]octreotate. Finally, compared with historical controls, there is a benefit in overall survival of several years from time of diagnosis in patients treated with [177Lu-DOTA0, Tyr3]octreotate. These data compare favorably with the limited number of alternative treatment approaches. If more widespread use of peptide receptor radionuclide therapy can be guaranteed, such therapy may well become the therapy of first choice in patients with metastasized or inoperable gastroenteropancreatic neuroendocrine tumors.Peptide Receptor Radionuclide Therapy in Patients With Gastroenteropancreatic Neuroendocrine TumorsDik J. Kwekkeboom, Wouter W. de Herder, Casper H.J. van Eijck, Boen L. Kam, Martijn van Essen, Jaap J.M. Teunissen, Eric P. Krenning10.1053/j.semnuclmed.2009.10.004Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-37888http://www.seminarsinnuclearmedicine.com/article/PIIS0001299809001019/abstract?rss=yesBone pain due to skeletal metastases constitutes the most common type of chronic pain among patients with cancer. It significantly decreases the patient's quality of life and is associated with comorbidities, such as hypercalcemia, pathologic fractures and spinal cord compression. Approximately 65% of patients with prostate or breast cancer and 35% of those with advanced lung, thyroid, and kidney cancers will have symptomatic skeletal metastases. The management of bone pain is extremely difficult and involves a multidisciplinary approach, which usually includes analgesics, hormone therapies, bisphosphonates, external beam radiation, and systemic radiopharmaceuticals. In patients with extensive osseous metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for pain palliation. In this article, we review the current approved radiopharmaceutical armamentarium for bone pain palliation, focusing on indications, patient selection, efficacy, and different biochemical characteristics and toxicity of strontium-89 chloride, samarium-153 lexidronam, and rhenium-186 etidronate. A brief discussion on the available data on rhenium-188 is presented focusing on its major advantages and disadvantages. We also perform a concise appraisal of the other available treatment options, including pharmacologic and hormonal treatment modalities, external beam radiation, and bisphosphonates. Finally, the available data on combination therapy of radiopharmaceuticals with bisphosphonates or chemotherapy are discussed.Systemic Metabolic Radiopharmaceutical Therapy in the Treatment of Metastatic Bone PainFabio M. Paes, Aldo N. Serafini10.1053/j.semnuclmed.2009.10.003Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-389104http://www.seminarsinnuclearmedicine.com/article/PIIS0001299809001056/abstract?rss=yesRadioembolization (RE), also termed selective internal radiation therapy (SIRT), has been gradually introduced to the clinical arsenal of cytoreductive modalities in recent years. There is growing evidence for efficiency in liver tumors of various entities, with the most prominent ones being hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors. Hepatic metastases of numerous other tumor entities including breast cancer, cholangiocarcinoma, and pancreatic cancer are treatment-sensitive, even when being refractory to other treatment modalities such as bland-embolization, regional, or systemic chemotherapy. The antitumor effect of SIRT is related to radiation rather than embolization, with extraordinary high local radiation doses obtained selectively at the site of viable tumor and little affection of the surrounding normal liver tissue. Morphologic changes after RE may pose difficulties for interpretation in conventional restaging with regard to tumor viability and true response to treatment. Therefore, functional imaging, that is, metabolic imaging with 18F fluorodeoxyglucose positron emission tomography (computed tomography) in the majority of treated tumors, is regarded the gold standard in this respect and should be included for pre- and post-SIRT assessment. To prevent serious toxicity to be associated with the potent antitumor efficacy, meticulous pretreatment evaluation is of particular importance. Improvements in predicting dosimetry will help optimize treatment and patient selection. Nuclear medicine procedures are essential for planning, performing, and monitoring of RE. However, the interdisciplinary aspect of patient management has to be emphasized for this particular treatment form. As SIRT is moving forward from the salvage setting indication to the use in earlier stages of hepatic tumor disease and with the advent of new treatment protocols and targeted therapies, embedding SIRT into a multidisciplinary approach will become even more important. This article focuses on procedural and technical aspects for selection, preparation, and performance of treatment as well as post-therapeutic monitoring and response assessment.Radioembolization of Liver Tumors With Yttrium-90 MicrospheresHojjat Ahmadzadehfar, Hans-Jürgen Biersack, Samer Ezziddin10.1053/j.semnuclmed.2009.11.001Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-3105121http://www.seminarsinnuclearmedicine.com/article/PIIS000129980900107X/abstract?rss=yesRadioimmunotherapy is a form of targeted radionuclide therapy that uses a monoclonal antibody to deliver localized radiation. It is most appropriate for treatment of multiple tumor sites that cannot be readily excised surgically or irradiated using external beam radiation or brachytherapy. At present, 2 products, Bexxar (131I-tositumomab and unlabeled tositumomab, GlaxoSmithKline, Triangle Park, NC) and Zevalin (90Y-ibritumomab tiuxetan and unlabeled rituximab, Spectrum Pharmaceuticals, Irvine, CA and Cell Therapeutics, Seattle, WA) are approved for treatment of non-Hodgkin's lymphoma in certain clinical situations in the United States and Canada. Zevalin is available also in Europe, and there are plans to make both agents more widely available. The therapeutic dose to be used depends upon a number of patient-specific variables. Both regimen achieve a complete response or partial response in approximately 3 of 4 patients, with a duration of remission lasting many years in some cases. This article reviews the basis for dose selection, the nuclear medicine procedures involved, the results obtained to date, and issues related to patient and staff safety.Radioimmunotherapy of Lymphoma: Bexxar and ZevalinStanley J. Goldsmith10.1053/j.semnuclmed.2009.11.002Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-3122135http://www.seminarsinnuclearmedicine.com/article/PIIS0001299809001032/abstract?rss=yesAlthough most patients with locoregional cancer are cured by surgery, radiotherapy, chemotherapy, and combinations thereof, those with distant metastases are not despite systemic chemotherapy. These patients respond to local radiotherapy but generally need systemic therapy. Non-Hodgkin's lymphoma (NHL) provides a paradigm for the role of molecular targeted radiotherapy (MTRT) because these patients have multifocal disease in most cases. Although patients with NHL achieve remissions after multiple cycles of chemotherapy, less than one half of those with aggressive NHL are cured and almost none of those with low grade NHL. Furthermore, NHL, like other cancers, becomes chemoresistant, yet remains responsive to radiotherapy. MTRT, radiation targeted by molecules, is a good strategy for the treatment of multifocal and radiosensitive cancers. Radioimmunotherapy (RIT) is an MTRT approach using MAbs, or parts thereof, to target the radionuclide that delivers radiation. Two anti-CD20 monoclonal antibodies (MAbs), one labeled with 111In for imaging or 90Y for therapy and a second labeled with 131I for imaging and therapy, have proven effective and safe for MTRT for NHL patients. The importance of the radiation is demonstrated in the data from the randomized pivotal trial of 90Y-ibritumomab; response rates were distinctly better in the 90Y-ibritumomab arm than in the rituximab arm. Furthermore, the efficacy of 131I-tositumomab was greater than that of the same MAb alone in another pivotal trial. Although hematologic toxicity is dose limiting for MTRT, febrile neutropenia is uncommon. MTRT is also not associated with mucositis, hair loss, or persistent nausea or vomiting, unlike chemotherapy. Randomized trials of MTRT in different strategies have not been conducted, but there is evidence of better outcomes, particularly for strategies that provide dose intensification, such as pretargeted MTRT, multiple dosing (“fractionation”), and MTRT with stem cell transplantation (SCT). Pretargeted RIT separates delivery of the targeting molecule from radionuclide delivery, provides dose escalation, and is more effective than direct one-step RIT, although more complicated to implement. Improved drugs and strategies for MTRT have documented potential for better patient outcomes. Smaller radionuclide carriers, such as those used for pretargeted MTRT, should be incorporated into the management of patients with NHL and other cancers soon after the patients have proven incurable. Expected improvements using better drugs, strategies, and combinations with other drugs seem likely to make MTRT integral in the management of many patients with cancer and likely to lead to cures of NHL.Dose Intensified Molecular Targeted Radiotherapy for Cancer—Lymphoma as a ParadigmGerald DeNardo, Sally DeNardo10.1053/j.semnuclmed.2009.10.005Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-3136144http://www.seminarsinnuclearmedicine.com/article/PIIS0001299809001044/abstract?rss=yesIn the past decade, the management of differentiated thyroid carcinoma changed significantly and thus contributed to the improvement of the already favorable prognosis of this malignant disease. Surgical treatment techniques improved and the extent of initial surgery is more individualized. Radioiodine therapy is an essential part of therapeutic regimens in almost all cases, and the use of recombinant human thyroid-stimulating hormone has established for ablation of remnant tissue, treatment of iodine-positive cancer, and sensitive thyroglobulin measurement during follow-up. Risk stratification has become more important to plan treatment and follow-up individually, particularly to evaluate the need for thyroid-stimulating hormone suppression therapy. Especially for inoperable and radioiodine-negative thyroid carcinomas, novel treatment options such as tyrosine kinase inhibitor therapy have emerged. This article deals with the current options of optimal therapy regimens in differentiated thyroid carcinoma.Update on Recent Developments in the Therapy of Differentiated Thyroid CancerMarcus Middendorp, Frank Grünwald10.1053/j.semnuclmed.2009.10.006Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-3145152http://www.seminarsinnuclearmedicine.com/article/PIIS0001299809001135/abstract?rss=yesTreatment with 131I-metaiodobenzylguanidine (MIBG) has been introduced to the management of neuroendocrine tumors (NET) nearly 30 years ago. It provides efficient internal radiotherapy of chromaffin tumors (neuroblastoma, pheochromocytoma, and paraganglioma), but also of carcinoid and other less frequent tumors. Although for various NET types the role of this treatment form decreased by the emergence of peptide receptor radionuclide therapy, 131I-MIBG still remains the primary radiopharmaceutical for targeting chromaffin tumors with outstanding efficiency. Results in neuroblastoma with overall response rates around 30% in refractory or recurrent diseases have been improved by combinations with chemotherapy, radiosensitizers, and autologous stem cell support. For adult chromaffin tumors, that is, pheochromocytoma and/or paraganglioma, 131I-MIBG therapy is currently the most efficient nonsurgical therapeutic modality and applies for inoperable, disseminated disease. The antisecretory effect with powerful palliation of symptomatic disease (response rate: 75%-90%) should also be considered when judging treatment benefit. The results in carcinoid tumors are less pronounced, primarily achieving arrest of tumor growth, and most importantly effective functional control. With the presence of peptide receptor radionuclide therapy, 131I-MIBG remains the alternative radionuclide in this tumor entity, for example, for patients with renal impairment. Another worthwhile mentioning indication—although less prevalent—are metastatic medullary thyroid carcinomas, especially if functioning. These patients are good candidates for this treatment form in the absence of reasonable surgical options and presence of diagnostic MIBG uptake. This article outlines the current status, results, and methodological improvements of 131I-MIBG therapy.131I-Metaiodobenzylguanidine Therapy of Neuroblastoma and Other Neuroendocrine TumorsFrank Grünwald, Samer Ezziddin10.1053/j.semnuclmed.2009.11.004Seminars in Nuclear Medicine 40, 2 (2010)2010-03-01Seminars in Nuclear Medicine2010-03-01402S0001-2998(09)X0007-3153163