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DOI: 10.1055/a-1802-8633
Bedeutung der Dosimetrie aus Sicht des Nuklearmediziners
Significance of dosimetry from the point of view of the nuclear physician
Zusammenfassung
Auch wenn bei der Radionuklidtherapie die individuelle Dosimetrie unter Mitwirkung des Medizin-Physik-Experten in der Strahlenschutzverordnung (StrSchV) festgeschrieben ist, bestehen unterschiedliche Auffassungen über das Ausmaß der Datenerfassung und auch technische Limitationen im Hinblick auf eine valide Bildgebung zur Bestimmung der Biokinetik. Dabei ist für die klinische Anwendung stets eine einfache und robuste Approximation zu bevorzugen.
Für wissenschaftliche Fragestellungen und für die Berücksichtigung der biologisch effektiven Dosis bedarf es jedoch valider Algorithmen, insbesondere für die Kombination interner und externer Radiotherapie. Die Anwendung von Alphastrahlern mit geringen Aktivitätsmengen und geringer Emissionswahrscheinlichkeit von Gammastrahlung zur Bilderzeugung zwingt jedoch teilweise, auf Standardaktivitätsmengen auszuweichen oder sich an Wirkung und Nebenwirkung analog zu anderer onkologischer Systemtherapie zu orientieren.
Abstract
Even though individual dosimetry (with the assistance of a medical physics expert) is stipulated in the Radiation Protection Ordinance (Strahlenschutzverordnung, StrSchV) for radionuclide therapy, there are different perceptions regarding the extent of data acquisition as well as the technical limitations keeping in mind visual imaging valid to determine the biokinetics. For clinical applications, always a simple approximation is preferred.
For scientific questions and considering the biological effective dose, valid algorithms are required, especially for the combination of internal and external radiotherapy. However, the application of alpha emitters with small amounts of activity and a low gamma yield for imaging partially demands switching to standardized activities or an orientation based on the clinical effect and corresponding side effects analogously to other oncological systemic therapies.
Publikationsverlauf
Artikel online veröffentlicht:
21. März 2023
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Literatur
- 1 Bolch WE, Eckerman KF, Sgouros G. et al. MIRD pamphlet No. 21: a generalized schema for radiopharmaceutical dosimetry--standardization of nomenclature. J Nucl Med 2009; 50: 477-484
- 2 Wayson MB, Bolch WE. Individualized adjustments to reference phantom internal organ dosimetry-scaling factors given knowledge of patient external anatomy. Phys Med Biol 2018; 63: 085007
- 3 Strigari L, Konijnenberg M, Chiesa C. et al. The evidence base for the use of internal dosimetry in the clinical practice of molecular radiotherapy. Eur J Nucl Med Mol Imaging 2014; 41: 1976-1988
- 4 Baechler S, Hobbs RF, Prideaux AR. et al. Extension of the biological effective dose to the MIRD schema and possible implications in radionuclide therapy dosimetry. Med Phys 2008; 35: 1123-1134
- 5 Poppel TD, Andreeff M, Becherer A. et al. Therapy of bone metastases with radium-223. German guidelines. Nuklearmedizin 2016; 55: 177-186
- 6 Dorn R, Kopp J, Vogt H. et al. Dosimetry-guided radioactive iodine treatment in patients with metastatic differentiated thyroid cancer: largest safe dose using a risk-adapted approach. J Nucl Med 2003; 44: 451-456
- 7 Madsen MT, Bushnell DL, Juweid ME. et al. Potential increased tumor-dose delivery with combined 131I-MIBG and 90Y-DOTATOC treatment in neuroendocrine tumors: a theoretic model. J Nucl Med 2006; 47: 660-667
- 8 Dietrich A, Andreeff M, Koi L. et al. Radiotherapy enhances uptake and efficacy of (90)Y-cetuximab: A preclinical trial. Radiother Oncol 2021; 155: 285-292
- 9 Freudenberg R, Hartmann H, Andreeff M. et al. Treatment Planning and Dose Verification for Combined Internal and External Radiotherapy (CIERT). Nuklearmedizin 2022; 61: 49-57
- 10 Poeppel TD, Boy C, Bockisch A. et al. Peptide receptor radionuclide therapy for patients with somatostatin receptor expressing tumours. German Guideline (S1). Nuklearmedizin 2015; 54: 1-11
- 11 Kissane DW. Marriage is as protective as chemotherapy in cancer care. J Clin Oncol 2013; 31: 3852-3853
- 12 Brix N, Tiefenthaller A, Anders H. et al. Abscopal, immunological effects of radiotherapy: Narrowing the gap between clinical and preclinical experiences. Immunol Rev 2017; 280: 249-279
- 13 Golden EB, Chhabra A, Chachoua A. et al. Local radiotherapy and granulocyte-macrophage colony-stimulating factor to generate abscopal responses in patients with metastatic solid tumours: a proof-of-principle trial. Lancet Oncol 2015; 16: 795-803
- 14 Levy A, Chargari C, Marabelle A. et al. Can immunostimulatory agents enhance the abscopal effect of radiotherapy?. Eur J Cancer 2016; 62: 36-45
- 15 Pouget JP, Constanzo J. Revisiting the Radiobiology of Targeted Alpha Therapy. Front Med (Lausanne) 2021; 8: 692436
- 16 Weichselbaum RR, Liang H, Deng L. et al. Radiotherapy and immunotherapy: a beneficial liaison?. Nat Rev Clin Oncol 2017; 14: 365-379
- 17 Verburg FA, Nonnekens J, Konijnenberg MW. et al. To go where no one has gone before: the necessity of radiobiology studies for exploration beyond the limits of the "Holy Gray" in radionuclide therapy. Eur J Nucl Med Mol Imaging 2021; 48: 2680-2682