1. Made by: Sara Allithey, Shatha Al Mushayt
2010
Therapeutic Application in
Nuclear Medicine

2. Outline
1. Introduction to therapeutic nuclear
medicine
2. Benefits vs. risks
3. Preparation
4. Applications of NM therapy
a. Radioactive iodine I-131 therapy
b. Palliative bone pain treatment
c. Zevalin
d. TheraSphere

3. Introduction
•Radioactive materials are used for therapeutic
irradiation of cells and/or organs.
•Typically, a small amount of a radiopharmaceutical
(Rph) is introduced into the body by injection or
ingestion.
•The Rph is attracted to particular organs or
tissues.
•From their locations, the radioisotope releases
small amounts of radiation which will act on target
cells and/or organs.
http://www.poole.nhs.uk/our_services/nuclear_medicine/therapeutic_procedures/what.
asp

4. Benefits
• Non-invasive treatment  less traumatic than
surgery.
• It is a systemic treatmentit targets sites which
may not be known to exist by the doctor.
• Only 1 injection or oral dose is needed normally.
• Patient can normally leave the hospital directly
after the procedure.
• Rph’s emitted ionizing radiation travels only a
short distance, thereby minimizing unwanted side
effects and damage to nearby structures.
http://www.poole.nhs.uk/our_services/nuclear_medicine/therapeutic_procedures/what.asp

5. Risks
• The total radiation received from radionuclide
therapy is generally so low; an insignificant risk
of causing cancer in the future.
• Effects on the blood forming organs are usually
short lasting and should be controlled by the
doctor.
• Radionuclide therapy is not carried out on
pregnant women.
• Allergic reactions to the Rph’s can
occur(extremely rare).
http://www.poole.nhs.uk/our_services/nuclear_medicine/therapeutic_procedures/what.asp

6. Patient preparation
•For some treatments no special preparation is
required.
•However for all treatment involving the thyroid
you must follow special advice regarding medicine
and diet.
http://www.poole.nhs.uk/our_services/nuclear_medicine/therapeutic_procedures/what.asp

7. Common Nuclear Medicine
therapies include:
• 131I-iodine for hyperthyroidism and
thyroid cancer or Mets.
• Yttrium-90-ibritumomab tiuxetan
(Zevalin) for Lymphoma.
• Samarium-153 or Strontium-89 for
palliative bone pain treatment.
• TheraSphere for liver cancer.

8. Radioactive iodine I-131 therapy
1. To treat hyperthyroidism (overactive
thyroid)
2. To treat thyroid cancer or Mets.
Capsule of I-131  absorbed into the
bloodstream in the GIT concentrate in
the thyroid glanddestroying the gland’s
cells.
http://www.radiologyinfo.org/en/glossary/glossary1.cfm?gid=641
Radioactive iodine -thyroid

9. Radioiodine ablation
• It is radiation therapy in which;
• Riodine is administered
• To destroy or ablate residual healthy
thyroid tissue remaining after
thyroidectomy.
http://www.thyca.org/ablation.htm

10. Zevalin
• Zevalin is used to treat follicular lymphoma.
• It combines a Y-90 radioisotope, with Monoclonal
antibody.
• It is given when lymphoma failed to be treated
with monoclonal AB alone.
Mechanism:
1. As Zevalin enters the bloodstream, the AB
recognises an antigen(called CD20) and attaches
to it.
2. Radiation is released from the yttrium
radioisotope, killing the B-cell.
http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttype
Ibritumomabtiuxetan.aspx-Y90s/Biologicaltherapies/Monoclonalantibodies/

12. Zevalin cont.
• Zevalin attacks both normal & malignant B-cell
lymphocytes.
• However, the body quickly replaces any normal
WBC’s that are damaged.
http://www.reuters.com/finance/stocks/companyProfile?symbol=SPPI.OQ
http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Biol
Ibritumomabtiuxetan.aspx-Y90/Monoclonalantibodies/ogicaltherapies

13. palliative bone pain treatment
1.metastron
• Metastron (strontium-89 chloride)
• IV injection used to relieve the bone pain
caused by cancer.
• It is similar to calcium chemically.
• It reaches the areas where bones are absorbing
extra calcium & causing pain then it stays
there for many weeks steadily providing pain
relief.
http://www.southend.nhs.uk/NR/rdonlyres/34D3FA0F-7E44-4677-9DA3-
E8D7DED59B9A/0/Metastrontreatment.pdf

14. palliative bone pain treatment
2.Quadramet
• Quadramet is a radiopharmaceutical (drug +
a Samarium-153 radioisotope).
• Used for patients with pain from cancer that
has spread to their bones.
• Quadramet finds areas of increased bone
growth and gives off radiation that reduces
pain.
http://www.poole.nhs.uk/our_services/nuclear_medicine
/therapeutic_procedures/quadramet.asp

15. TheraSphere
• Radiation treatment for liver cancer that cannot be
removed by surgery e.g. HCC.
• Involves injecting a large number of tiny radioactive
glass beads (TheraSpheres) into the liver arteries.
• The TheraSpheres travel through the blood vessels until
they lodge into the smaller blood vessels of the liver
tumor.
• The beads stay there and give off radiation that
destroys the cancer cells with little injury to the healthy
liver.
• After 3 days, the beads lose their radioactivity. Image
http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-
Show_Public_HFFY_1126651799450.html

17. Thank
You