The analysis of attenuation factors for therapeutic radioisotopes in Indonesia: Preparation of image quantification for radionuclide therapy dosimetry
Syarifatul UlyaPrasetya WidodoWiwin MailanaA. HaqueOkky Agassy FirmansyahNunung NuraeniNur Rahmah HidayatiMarlina MarlinaTitis Sekar HumaniBisma Barron Patrianesha
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Radionuclide therapy
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Preface RADIATION ROUND-UP: Introductory Aspects of Radiation Basic Concepts of Radiation Physics and Dosimetric Units IONIZATION METHODS: Ionization Chamber Dosimetry Semiconductor-Junction Dosimetry Ion Implantation Dosimetry THERMAL METHODS: Thermoluminescence Dosimetry Thermally Stimulated Conductivity (TSC) Dosimetry Electret Dosimetry Exoelectron Dosimetry OPTICAL METHODS: Film Dosimetry Solid State Nuclear Track Dosimetry CHEMICAL METHODS: Chemical Dosimetry Lyoluminescence Dosimetry Calorimetric Dosimetry-I Calorimetric Dosimetry-II Electron Spin Resonance Dosimetry Appendix Subject Index.
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Background: Neuroendocrine carcinomas (NECs) are rare malignancies with limited treatment options beyond surgery. Peptide receptor radionuclide therapy (PRRT) is a process by which a somatostatin analog (octreotate) is combined with a chelator (DOTA) and a radionuclide (lutetium-177 [177Lu-dotatate]). This therapy targets receptors on neuroendocrine cells, causing internalization of the radionuclide by the tumor cell, which results in cellular damage and apoptosis. Case Report: We describe the clinical and therapeutic course of a 69-year-old male with a metastatic rectal NEC in whom progressive disease was noted after multiple therapies were attempted. After PRRT with 177Lu-dotatate, the patient was asymptomatic and demonstrated a near-complete radiologic response. Conclusion: This case illustrates that treatment with PRRT may improve the outcome of patients with metastatic rectal NEC. Our case highlights the importance of further research into the use of PRRT in patients with a Ki-67 <55% and uptake on somatostatin receptor imaging.
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Peptide receptor
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Abstract We present here a case with β-radiation–refractory metastatic neuroendocrine tumors, who demonstrated an excellent therapy response after 1 cycle of 225 Ac-DOTATOC, without any significant adverse effects even after 10 cycles of β-emitter peptide receptor radionuclide therapy followed by α-peptide receptor radionuclide therapy.
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Refractory (planetary science)
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A simple artificial neural network is considered for real-time estimation of excess atmospheric attenuation on a satellite communication link with known attenuation at two frequencies. All atmospheric contributors to attenuation are considered except for gases. The network has a two-layer feed-forward structure with 32 neurons in the hidden layer. Its performance is evaluated by computer simulation using 447 hours of measured attenuation data at 20, 40, and 50 GHz. Estimated attenuation tracks well the measured attenuation at 50 GHz. Estimation error standard deviation is 0.36 dB. RMS error is a function of attenuation: it increases slowly with attenuation, but the ratio of error to attenuation decreases with increasing attenuation. This approach accurately estimates excess attenuation without requiring assumptions, but required training data. (4 pages)
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Peptide receptor radionuclide therapy (PRRT) with [177Lu-DOTA0,Tyr3]octreotate (177Lu-DOTATATE) is a treatment with good results in patients with metastatic gastroenteropancreatic neuroendocrine tumours (GEPNETs). However, there are some pitfalls that should be taken into consideration when evaluating the treatment response after PRRT. 354 Dutch patients with GEPNETs who were treated with 177Lu-DOTATATE between March 2000 and December 2011 were retrospectively selected. Liver function parameters and chromogranin A were measured before each therapy and in follow-up. Anatomical imaging was performed before therapy and in follow-up. An increase in aminotransferases by ≥20% compared to baseline was observed in 83 of 351 patients (24%). In patients with an objective response (OR) and stable disease (SD) this increase was observed in 71/297 (24%) and in patients with progressive disease (PD) it was observed in 12/54 patients (22%). An increase in chromogranin A by ≥20% compared to baseline was observed in 76 patients (29%). This was present in 34% of patients who eventually had PD and 27% of patients who had OR/SD. In 70% of patients this tumour marker returned to baseline levels after therapy. An increase in liver enzymes and chromogranin A is not uncommon after PRRT. In the vast majority of patients this will resolve in follow-up. Clinicians should be aware that these changes may occur due to radiation-induced inflammation or disease progression and that repeated measurements over time are necessary to differentiate between the two.
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Radionuclides have been long used for the palliation of skeletal-related metastatic pain. They are almost invariably used as the last resource for pain palliation. Their use as single agents with dose escalations, in combination with biphosphonates or chemotherapy is well known in the peer-reviewed literature; however, little is known about the combination between different agents. In our study, we used consecutive administration of 2 different radionuclides such as (186)Re-1,1-hydroxyethylidenediphosphonate ((186)Re-HEDP) and (89)Strontium Chloride ((89)Sr-Cl) separated by adequate period of time to allow bone marrow recovery in patients with high chance of bone pain relapse and compared it with (89)Sr-Cl and chemotherapy group and (186)Re-HEDP with bisphosphonates. The end result was that treatment with consecutive radionuclides was much more effective and safe than the other 2 groups.
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Peptide receptor radionuclide therapy (PRRT) is a highly effective anti-cancer treatment modality for patients with non-resectable, metastasized neuroendocrine tumors (NETs). During PRRT, specific receptors that are overexpressed on the cancer cells are targeted with a peptide labeled with a DNA-damaging radionuclide. Even though PRRT is a powerful treatment for metastasized NET patients, the majority still cannot be cured at this stage of the disease. Hence, many investigators focus on improving the therapeutic efficacy of this therapy. Improving PRRT can, for example, be achieved by using other radionuclides with different physical properties, by combining PRRT with radiosensitizing agents or by radiolabeling peptides with different characteristics. However, due to lack of extensive knowledge of radiobiological responses of cancer cells to PRRT, biological parameters that influence absorbed dose or that might even elicit insensitivity to therapy remain elusive and the context in which these improvements will be successful warrants further investigation. In this review, we will discuss the development of PRRT, its clinical merits in current treatment and future perspectives. We will highlight different radionuclides and their benefits and pitfalls, as well as different peptide-conjugates that hold these radionuclides. We will zoom in on the latest developments regarding combinatorial treatments and how investigators from different disciplines such as dosimetry and radiobiology are now joining forces to improve PRRT for NETs.
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