Full Text | PDF

Theranostics 2022; 12(1):232-259. doi:10.7150/thno.62851 This issue Cite

Review

Implications of physics, chemistry and biology for dosimetry calculations using theranostic pairs

Cassandra Miller^1,2, Julie Rousseau³, Caterina F. Ramogida^4,5, Anna Celler⁶, Arman Rahmim^1,2,6, Carlos F. Uribe^6,7✉

1. Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada.
2. Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.
3. Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC, Canada.
4. Department of Chemistry, Simon Fraser University, Burnaby, BC, Canada.
5. Life Sciences Division, TRIUMF, Vancouver, BC, Canada.
6. Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
7. PET Functional Imaging, BC Cancer Research Centre, Vancouver, BC, Canada.

✉ Corresponding author: Carlos Uribe, E-mail: curibeca.

Abstract

Theranostics is an emerging paradigm that combines imaging and therapy in order to personalize patient treatment. In nuclear medicine, this is achieved by using radiopharmaceuticals that target identical molecular targets for both imaging (using emitted gamma rays) and radiopharmaceutical therapy (using emitted beta, alpha or Auger-electron particles) for the treatment of various diseases, such as cancer. If the therapeutic radiopharmaceutical cannot be imaged quantitatively, a “theranostic pair” imaging surrogate can be used to predict the absorbed radiation doses from the therapeutic radiopharmaceutical. However, theranostic dosimetry assumes that the pharmacokinetics and biodistributions of both radiopharmaceuticals in the pair are identical or very similar, an assumption that still requires further validation for many theranostic pairs. In this review, we consider both same-element and different-element theranostic pairs and attempt to determine if factors exist which may cause inaccurate dose extrapolations in theranostic dosimetry, either intrinsic (e.g. chemical differences) or extrinsic (e.g. injecting different amounts of each radiopharmaceutical) to the radiopharmaceuticals. We discuss the basis behind theranostic dosimetry and present common theranostic pairs and their therapeutic applications in oncology. We investigate general factors that could create alterations in the behavior of the radiopharmaceuticals or the quantitative accuracy of imaging them. Finally, we attempt to determine if there is evidence showing some specific pairs as suitable for theranostic dosimetry. We show that there are a variety of intrinsic and extrinsic factors which can significantly alter the behavior among pairs of radiopharmaceuticals, even if they belong to the same chemical element. More research is needed to determine the impact of these factors on theranostic dosimetry estimates and on patient outcomes, and how to correctly account for them.

Keywords: radiopharmaceutical therapy, theranostics, dosimetry, personalized medicine, radiopharmaceuticals

Citation styles

©2024 Ivyspring International Publisher. Terms of use