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Theranostic Applications of Lutetium-177 in Radionuclide Therapy
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2015
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Lutetium‑177 is a preferred radioisotope for targeted radionuclide therapy due to its simultaneous emission of imageable gamma photons (208 keV, 11 % and 113 keV, 6.4 %) and β‑particles (βmax 497 keV), enabling theranostic applications. The study investigates the use of 177Lu‑EDTMP and 177Lu‑DOTATATE for theranostic applications in metastatic bone pain palliation and peptide receptor radionuclide therapy. Whole‑body imaging with 177Lu‑EDTMP was compared to 99mTc‑MDP, while pre‑therapy images from 177Lu‑DOTATATE were compared to 99mTc‑HYNIC‑TOC (SPECT) and 68Ga‑DOTA‑TOC (PET) in the same patients. The long half‑life of 177Lu enabled pharmacokinetic mapping of 177Lu‑HA in knee joint radiation synovectomy and hepatocellular carcinoma therapy, and the studies collectively confirm 177Lu’s potential as a theranostic radioisotope.
Lutetium-177 has been widely discussed as a radioisotope of choice for targeted radionuclide therapy. The simultaneous emission of imageable gamma photons [208 keV (11%) and 113 keV (6.4%)] along with particulate β- emission [β(max) = 497 keV] makes it a theranostically desirable radioisotope. In the present article, the possibility of using two 177Lu-based agents viz. 177Lu-EDTMP and 177Lu-DOTATATE for theranostic applications in metastatic bone pain palliation (MBPP) and peptide receptor radionuclide therapy (PRRT), have been explored. In the case of 177Lu-EDTMP, the whole-body images obtained are compared with those recorded using 99mTc-MDP in the same patient. On the other hand, pre-therapy images acquired with 177Lu-DOTA-TATE are compared with similar images obtained with standard agents, such as 99mTc-HYNIC-TOC (SPECT) and 68Ga-DOTA-TOC (PET) in the same patient. The advantage of the long physical half-life (T1/2) of 177Lu has been utilized in mapping the pharmacokinetics of two additional agents, 177Lu-labeled hydroxyapatite (HA) in radiation synovectomy of knee joints and 177Lu-HA for therapy of hepatocellular carcinoma. Results of these multiple studies conclusively document the potential of 177Lu as a theranostic radioisotope Keywords: 177Lu, Theranostic applications, Metastatic bone pain palliation, Peptide receptor radionuclide therapy, Pharmacokinetic mapping.