Radiation protection in therapy with radiopharmaceuticals

Abstract

Purpose: Radionuclide therapy (RNT) involves the selective delivery of radiation, emitted from radionuclides to tumors or target organs. The techniques of RNT are increasingly being used for the treatment of various tumors. The purpose of this article is to report on the current state of RNT, to clarify the issues of radiation protection associated with RNT, and to show future prospects.

Results and conclusions: Medical exposure of patients has unique features; application of dose limits is not undertaken, and justification and optimization do apply but in a different way from in other exposures. The expanding use of RNT has raised concern regarding potential carcinogenic and leukemogenic effects and research on second primary cancer after RNT have been developing. RNT combined with imaging and dosimetry and featuring a theranostic approach is undergoing a significant expansion, and such dosimetry-based treatment planning leads to individualization, or personalization, which is likely to improve the effectiveness and safety of patient management in RNT.

Keywords:

• radionuclide therapy
• theranostics
• dosimetry
• second primary cancer

Acknowledgements

The author is grateful to Drs. Yoshiharu Yonekura, Sören Mattsson, Wesley Bolch, Glenn Flux, Darrell Fisher, Stig Palm, Keon Kang, and Reiko Kanda for their great supports in summarizing updates on scientific reports.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Japan Society for the Promotion of Science KAKENHI Grant Number JP 18K07651; Ministry of Health, Labour and Welfare Health Labour Sciences Research Grant Number 201721015A and Nuclear Regulation Agency Grant on management of short-lived alpha emitters.

Notes on contributors

Makoto Hosono

Makoto Hosono, MD, PhD, is Professor of Institute of Advanced Clinical Medicine and Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan, and serves as a member of ICRP C3 since 2017. He has been contributing to the fields including nuclear oncology and tumor targeting. He serves as the chair of PET Committee since 2011 of Japanese Society of Nuclear Medicine (JSNM) and as the chair of Radionuclide Therapy Committee of Japan Radioisotope Association (JRIA).