Radionuclide Therapy: Guidelines
This guidance document is aimed at assisting and guiding nuclear medicine specialists in: 1. Assessing patients with neuroendocrine tumours (NETs) for their eligibility to undergo treatment with 90Y- or 177Lu-radiolabelled somatostatin analogues. 2. Providing guidance on performing peptide receptor radionuclide therapy (PRRNT) and implementing this treatment in a safe and effective manner. 3. Understanding and evaluating the outcome of PRRNT, namely treatment results and possible side effects including both renal and haematological toxicities. A committee of international experts was assembled under the auspices of the International Atomic Energy Agency (IAEA), in cooperation with the EANM Therapy, Oncology and Dosimetry Committees and with the Society of Nuclear Medicine and Molecular Imaging. They worked together to create this guidance document on the use of somatostatin analogue-based PRRNT. This guidance document was compiled taking into account recent literature and experts’ opinion.
SNM Procedure Guideline for Therapy of Thyroid Disease with Iodine-131I 3.0 (2012)
The purpose of this guideline is to assist nuclear medicine practitioners in evaluating patients for therapy with 131I (sodium iodide) for benign or malignant conditions of the thyroid gland, performing this treatment, understanding and evaluating the sequelae of therapy, and reporting the results of therapy.
The purpose of this guideline is to assist nuclear medicine specialists in: 1. Evaluating patients who might be candidates for treatment using intra-arterial radioactive compounds for primary or secondary liver cancer 2. Providing information for performing this treatment 3. Understanding and evaluating the consequences of this therapy
This guideline was approved by the ESMO Guidelines Working Group: Levels of Evidence [I–V] and Grades of Recommendation [A–D] as used by the American Society of Clinical Oncology are given in square brackets. Statements without grading were considered justified standard clinical practice by the experts and the ESMO faculty.
EANM Dosimetry Committee guidelines for bone marrow and whole-body dosimetry (2010)
The level of administered activity in radionuclide therapy is often limited by haematological toxicity resulting from the absorbed dose delivered to the bone marrow. The purpose of these EANM guidelines is to provide advice to scientists and clinicians on data acquisition and data analysis related to bone-marrow and whole-body dosimetry.
EANM procedure guidelines for therapy of benign thyroid disease (2010)
The purpose of the present guidelines on the 131I therapy of benign thyroid disorders formulated by the European Association of Nuclear Medicine (EANM) Therapy Committee is to provide advice to nuclear medicine clinicians on how to treat benign thyroid conditions employing optimal 131I activities. The recommendations were formulated based on recent literature and expert opinion regarding rationale, indications and contraindications for the use of 131I procedures, as well as the adequate 131I activities in different thyroid disorders, and the administration and patient preparation techniques to be used. Recommendations are also provided on history and examinations before 131I therapy, patient counselling and precautions associated with 131I therapy. Furthermore, potential side effects and alternative treatment modalities are reviewed. Special attention is paid to these aspects in the treatment of children undergoing this procedure.
EANM procedure guidelines for I-131-meta-iodobenzylguanidine (131I-mIBG) therapy (2008)
The purpose of this guideline is to assist nuclear medicine practitioners to 1. Evaluate patients who might be candidates for 131I-metaiodobenzylguanidine (mIBG) to treat neuro-ectodermal tumours, 2. Provide information for performing this treatment and 3. Understand and evaluate the consequences of therapy.
Meta-iodobenzylguanidine, or Iobenguane, is an aralkylguanidine resulting from the combination of the benzyl group of bretylium and the guanidine group of guanethidine (an adrenergic neurone blocker). It is a noradrenaline (norepinephrine) analogue and so-called “false” neurotransmitter. This radiopharmaceutical, labeled with 131I, could be used as a radiotherapeutic metabolic agent in neuroectodermal tumours, that are derived from the primitive neural crest which develops to form the sympathetic nervous system. The document has been endorsed by the SNMMI Board.
Guidelines for radioiodine therapy of differentiated thyroid cancer (2008)
The purpose of the present guidelines on the radioiodine therapy of differentiated thyroid cancer (DTC) formulated by the European Association of Nuclear Medicine (EANM) Therapy Committee is to provide advice to nuclear medicine clinicians and other members of the DTC-treating community on how to ablate thyroid remnant or treat inoperable advanced DTC or both employing large 131I activities. Radioiodine therapy is defined as the systemic administration of 131-sodium or potassium iodide (131I) for selective irradiation of thyroid remnants, microscopic DTC or other nonresectable or incompletely resectable DTC, or both purposes. Based on the primary goal of the therapy, there are two main forms of the procedure.
EANM procedure guideline for treatment of refractory metastatic bone pain (2008)
The purpose of this guideline is to assist nuclear medicine practitioners in: 1. Evaluating patients who might be candidates for treatment to palliate refractory, metastatic bone pain using 89Sr (approved in Europe for prostate cancer), 153Smlexidronam (153Sm-EDTMP; approved in Europe for osteoblastic metastases) or 186Re-etidronate (186Re- HEDP; approved in some European countries). 2. Providing information for performing these treatments. 3. Understanding and evaluating the consequences of therapy.
Bone-seeking radiopharmaceuticals are one of the therapeutic tools available for palliation of bone pain and should be used within a multidisciplinary approach to choose the best option for each patient in a correct sequence. Substantial advantages of bone palliation radionuclide therapy include the ability to simultaneously treat multiple sites of disease with a more probable therapeutic effect in earlier phases of metastatic disease, the ease of administration, the repeatability, and the potential integration with the other treatments.
EANM procedure guideline for P-32 phosphate treatment of myeloproliferative diseases(2007)
The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients who may be candidates for 32P phosphate therapy. It is used for patients with Polycythaemia Vera and Essential thrombocythaemia. 32P is actively incorporated into
the nucleic acids of rapidly proliferating cells. The radiopharmaceutical is used to suppress hyperproliferative cell lines rather than to eradicate them.
The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients who may be candidates for radioimmunotherapy. EMEA has approved 90Y-radiolabelled ibritumomab tiuxetan, Zevalin®, in Europe for the treatment of adult patients with rituximab-relapsed or -refractory CD20+ follicular B-cell non-Hodgkin´s lymphoma (NHL) in January 2004. Being a pure beta-emitter with a pathlength of 100-200 cell diameters, 90Y has a broad crossfire effect when it is conjugated to monoclonal antibody such as ibritumomab. The document has been endorsed by the SNMMI Board.
SNM Procedure Guideline for Palliative Treatment of Painful Bone Metastases (2003)
The purpose of this guideline is to assist nuclear medicine practitioners in evaluating patients who
might be candidates for 32P-sodium phosphate, 89Srchloride, or 153Sm-lexidronam (153Sm-EDTMP) radiopharmaceutical treatment of bone pain due resulting from osteoblastic metastases, to provide information for performing this treatment, and to assist in understanding the sequelae of therapy.
EANM Procedure Guidelines for I-131- Ethiodised Oil (Lipiodol) Therapy (2002)
The purpose of this guideline is to assist nuclear medicine practitioners in evaluating patients who might be candidates for treatment using 131I lipiodol for primary hepatocellular carcinoma, providing information for performing this treatment and understanding and evaluating the sequelae of therapy. Ethiodised oil, also known as Lipiodol is a naturally iodinated fatty acid ethyl ester of poppy seed oil. After hepatic intra-arterial injection, 131I-Lipiodol follows arterial flow towards the tumour and is trapped in tumour microvessels.
The purpose of this guideline is to assist nuclear medicine practitioners in: 1. Evaluating patients who might be candidates for intra-articular treatment using colloidal preparations of 90Y, 186Re or 169Er 2. Providing information regarding the performance of these treatments. 3. Understanding and evaluating the sequelae of therapy.