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Het Tijdschrift voor Nucleaire Geneeskunde (TvNG) is een Nederlandstalig kwartaalblad dat wordt verspreid onder de leden van de aangesloten beroepsverenigingen in Nederland en België en onder belangstellenden die zich als abonnee hebben aangemeld. Doelstelling van het tijdschrift is het bevorderen van discussie en uitwisselen van kennis tussen beroepsbeoefenaren in de nucleaire geneeskunde.

Jun '23. Palliative radionuclide therapy for bone metastases with strontium-89-chloride and samarium

A considerable proportion of patients with cancer will develop bone metastases. Bone metastases frequently cause severe bone pain and seriously affect quality of life. Palliative treatment of patients with bone pain from multiple bone metastases using radiopharmaceuticals such as [89Sr]SrCl2 and [153Sm]Sm-EDMTP can be a safe and easily accessible option to effectively relieve bone pain.

Jun '23. [131I]mIBG therapy in neuroblastoma – 35 Years of experience

Neuroblastoma is the most common extracranial solid malignancy of childhood. Approximately half of patients have high-risk neuroblastoma (HR-NBL), typically presenting with widespread metastatic disease at diagnosis. Despite aggressive multimodality treatment, patients with HRNBL have a long-term survival of less than 50%, due to a high relapse/progression rate and therapy-resistant disease.

Jun '23. Current status of clinical dosimetry and personalized radionuclide therapy

The number of patients treated with radionuclide therapy (RNT) has made a giant leap with the approval of targeted Lutetiumlabelled radiopharmaceuticals by the European Medicines Agency (EMA). Though treatments with radioiodine still make up for over 85% of the RNTs in Europe, the scientific breakthroughs are nowadays achieved with new radiolabelled small-molecules and microspheres in various oncological settings.

Jun '23. Peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumours

Neuroendocrine neoplasms are a rare type of tumour that typically have a slow growing pattern. Most neuroendocrine tumours express high levels of somatostatin receptors type 2 (SSTR-2) on their cell surface. These receptors are a potential target for radiolabelled somatostatin analogues. Since 2017, peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTATATE is EMA and FDA approved for treatment of metastatic and/or advanced gastroenteropancreatic neuroendocrine tumours (GEPNETs).

Jun '23. Radiosynoviorthese in persisterende synovitis, relatief onbekend en ondergebruikt in Nederl

Het concept radiosynoviorthese of radiatie synovectomie (RSO), oftewel het intra-articulair toedienen van een radio-isotoop ter behandeling van artritis of synovitis, werd ongeveer een eeuw geleden voor het eerst beschreven in de medische literatuur. Een van de vroegste publicaties over toediening van radio-isotopen in gewrichten stamt uit 1924 en de eerste klinische resultaten van RSO werden in 1952 gepubliceerd door Fellinger en Schmid. Op dit moment wordt deze nucleair geneeskundige therapie in sterk wisselende mate uitgevoerd op verschillende plekken in de wereld.

Jun '23. Lutetium-177 PSMA for prostate cancer, current developments and challenges

[177Lu]Lu-PSMA has shown to be effective and safe in patients with metastatic castration resistant prostate cancer (mCRPC), leading to Food and Drugs Authorization (FDA) approval in the United States of America for [177Lu]Lu-PSMA-617 in March 2022 and to European Medical Agency (EMA) approval in December 2022. In the Netherlands, [177Lu]Lu-PSMA-I&T is reimbursed since August 2021 for the same indication. This illustrates that a lot has happened since our initial report on [177Lu]Lu-PSMA in the previous therapy special edition of Tijdschrift voor Nucleaire Geneeskunde, five years ago. This review will summarize recent scientific developments on [177Lu]Lu-PSMA radioligand therapy. The most notable and impactful prospective trials included the TheraP-, and VISIONtrial investigating [177Lu]Lu-PSMA-617 in mCRPC patients. They will be discussed in more detail.

Jun '23. Radium-223 bij gemetastaseerd castratieresistent prostaatcarcinoom

Behandeling met [223Ra]RaCl2 is veilig en effectief bij patiënten met gemetastaseerd castratieresistent prostaatkanker (mCRPC) met symptomatische botmetastasen. Het huidige onderzoek richt zich op het vinden van predictieve parameters voor respons op de behandeling en op de mogelijkheid de 223Ra-behandeling te combineren met andere (reeds goedgekeurde) vormen van therapie bij mCRPC.

Jun '23. Radioembolization: An update on current practice and recent developments

Since the 1950s, when it became clear that hepatic tumors derive their blood supply primarily from the hepatic artery and normal hepatic parenchyma primarily receives it blood from the portal vein, there has been growing interest into hepatic artery-directed treatments. Dr. Irving Ariel was the first to describe the technique of radioembolization in 1965. Via a groin puncture and femoral artery access, 90Y loaded ceramic microspheres were administered through a catheter in the celiac artery.

Jun '23. Beeldgestuurd behandelen – Holmium-166 therapie geleid door CT en MRI

Holmium-166 microsferen (HoMS) vonden hun oorsprong in 1991, en al snel werd de ontwikkeling van de microsferen met deze bèta-- (β-) en gamma-emitter (γ) doorgezet binnen fundamenteel en preklinisch onderzoek in het UMC Utrecht. Er gingen jaren overheen voor de optimale vorm van de microsferen werd gevonden. Het eindproduct, holmiumacetylacetonaat in een matrix van polymelkzuur met een gemiddelde diameter van 30 μm, werd in 2009 voor het eerst gebruikt ter behandeling van patiënten met verscheidene typen levertumoren zonder verdere behandelopties. De behandeling is gelijk aan de behandeling met de in 2001 op de markt verschenen yttrium-90 (90Y) microsferen, en wordt zowel selectieve interne radiotherapie (SIRT) als transarteriële radioembolisatie (TARE) genoemd.

Jun '23. De-escalating Thyroid Cancer Treatment: Indications for Thyroid Remnant Ablation and Adjuva

Patients with differentiated thyroid cancer have an excellent prognosis. After the diagnosis of differentiated thyroid cancer most patients undergo a total thyroidectomy followed by radioiodine therapy. In recent years it has become evident that not all patients need extensive surgical treatment and post-operative radioiodine therapy. This article describes the current indications for radioiodine therapy after thyroidectomy for differentiated thyroid cancer.

Jun '23. Understanding the radiobiology of therapeutic medical radionuclides (UNRANU)

December 14th, 2022, the UNRANU research proposal was awarded by the Dutch Research Council (NWO) within the Perspectief program. This Perspectief funding instrument supports projects that contribute to the creation of economic opportunities within the societal challenges and key technologies of the Mission-driven Innovation Policy of NWO. Within UNRANU, we aim to improve the radiobiological knowledge and accessibility of therapeutic isotopes for radionuclide therapy (RNT). Ultimately, this would improve the availability of RNT, contribute to more rationalized treatment selection and/or treatment planning, with the final goal to help more cancer patients with a better disease outcome.

Jun '23. 2021 guideline on radiation exposure after radionuclide therapies: implementation in clinic

National guidelines on radionuclide therapies have long been based on a 2005 report (Aanbevelingen ‘Het werken met therapeutische doses radionucliden’), mainly based on iodine-131 ([131I]NaI) therapies. As new therapies were introduced, mainly lutetium-177 ([177Lu]Lu) based - with less radiation burden for the environment – and with the implementation of the 2013 basic safety standards directive in European legislation, an update was necessary. In the meantime, dose rate levels for discharge after [177Lu]Lu were used in the way they were used for [131I]NaI (20 μSv/h at 1m). Guidelines were revised and implemented by the FMS in 2021, in hopes to reach more uniformity between hospitals as well. We investigated this pursued uniformity by the new guideline and provide insights into its implementation.