The fact that the researchers could simplify the imaging process reduced the number of imaging sessions from four to one per patient and treatment, with retained quality.
Congratulations on winning the prize!
“Thank you! It was a lovely surprise for us and we were quite astonished when we heard about it”, says Anna Sundlöv, doctoral student at Lund University and cancer physician at Skåne University Hospital. She is the first author of the article and will receive the prize on 13 October at a congress in Barcelona.
In her everyday clinical work, Anna Sundlöv is involved in using radiopharmaceuticals to treat tumours. The radioactive, target-seeking drug is administered to the patient in drops and then finds its way via the bloodstream to its target, in this case a receptor that is in the tumour cells. Once inside the tumour cells, it releases its cell-killing radiation. One advantage of these radiopharmaceuticals is that they can be used for both treatment and imaging, so-called “theranostics” (see fact box).
“Using imaging, it’s possible to follow the passage of our drug in the patient and measure its effect in the body. From the images you can calculate the radiation doses obtained in the tumour and healthy organs – especially the kidneys – which risk being damaged if they receive too much radiation”, explains Anna Sundlöv.
In these cases, it is important to attack the tumour using the highest possible radiation dose, while also keeping below the risk levels for healthy organs and tissue.
A way to personalise treatment
The drug they investigated in the study is based on the active substance 177Lutetium-DOTATATE and was recently approved for the treatment of neuroendocrine tumours by the American and European drug regulation authorities.
“The clinical trials of the drug did not take the opportunity to use imaging-based dosimetry to examine how you can clinically personalise the treatment. That is what we have now done in the study”, says Katarina Sjögreen Gleisner, the last author of the study.
Every other month, the 103 patients involved in the study were treated at Skåne University Hospital and Sahlgrenska Hospital using 177Lutetium-DOTATATE for their scattered neuroendocrine tumours. After each treatment, images were taken on four different occasions over a one-week period (see image) – a labour and resource-intensive approach that is also awkward for the patients, who need to get to the hospital several times a week. However, based on the images in the database, the researchers have been able to work out how it is possible to retain the exactitude of the dose calculations while simplifying the approach.
The result in the study was a reduction in the number of imaging sessions from four to one per patient and treatment.
“This means that in the everyday clinical world, imaging can be used as a way to personalise treatment”, says Anna Sundlöv.
“Translational research in all possible directions”
There has been a collaboration between medical radiation physics at the University and oncology at the hospital for over 20 years. The collaboration has included systematic work to improve methods for the planning of cancer treatment.
“It’s not possible for me to do this without Katarina and her physicist colleagues, and they need our clinical questions and patient material. For 40 years, public healthcare has taken images and looked at them qualitatively for diagnostic purposes, but Katarina and her team at medical radiation physics have now quantified the images in a therapeutic context. The study has resulted in us being able to introduce this as a part of the treatment at the clinic”, says Anna Sundlöv.
Katarina Sjögreen Gleisner agrees:
“It’s a strength that we can bring in specialist expertise from both areas and unite them in this article. It’s often the case that the benefits of research are not seen until many years later, but a great driving force in this is that we see the benefit of the research in the near future”, says Katarina Sjögreen Gleisner.
FACTS:
Theranostics is a portmanteau word that combines “therapy” and “diagnostics”. The word indicates a new direction in nuclear medicine in which a target-seeking molecule searches out a target that is specific for a certain type of tumour. Linking different types of radioactive isotopes to the target-seeking molecule provides a possibility for either imaging (“diagnostics”) or treatment (“therapy”), or both, depending on the selected isotope. The isotope used in the drug examined in this referenced clinical study is 177Lutetium, which is well suited for both diagnostics and therapy. Based on the images taken after one treatment, it is possible to calculate how much radiation has been delivered to the tumour and the healthy tissues (radiation dosimetry), which in turn can be used to adapt the treatment to what each individual patient can tolerate.
Publication: Feasibility of simplifying renal dosimetry in 177Lu peptide receptor radionuclide therapy
