Therapeutic Radionuclides in Nuclear Medicine

Dear Colleagues,

Sodium iodide is the first example of a theranostic radiopharmaceutical wherein diagnostic (¹²³I, ¹²⁴I) and therapeutic (¹³¹I) radionuclides are used, respectively for diagnostic imaging and subsequent radiotherapy. It has been in clinical application since the 1940s and received the first FDA approval for the use of radioactive material for cancer treatment. The visualization of regional distribution in the context of pretherapeutic dosimetry and post therapeutic biodistribution is a prerequisite for robust methodology and broad clinical use.

Recently, the theranostic principle has been used with tumor receptor-specific radiopharmaceuticals containing therapeutic nuclides, such as ¹⁶¹Tb, ¹⁷⁷Lu, ¹⁸⁸Re, ²¹²Pb, ²²⁵Ac. The production mode, availability, and costs of radionuclides have a significant impact on their clinical use and is often a bottleneck for broad application. Therefore, cyclotron-produced neutrons could open a new era for producing relevant radionuclides.

Identification of tumor-specific binding sites, development of tumor-addressing conjugates, and opportunities for enhanced target enrichment and the protection of critical organs define the potential of therapeutic radiopharmaceuticals. The combination of radiotherapeutics with other pharmaceuticals to modulate the target or repair systems exploits synergistic effects. Combining radiotherapeutics with the body's immune system or immunotherapeutics raises hopes for immunization against cancer and could explain the success of targeted alpha therapy vs. targeted beta therapy. The value of diverse radiation qualities including options such as photodynamic therapy using Cherenkov light must be systematically investigated in vitro and in preclinical models before they can be used in clinical trials and patient care.

The path from radioisotope to targeted radionuclide therapy encompasses a multitude of aspects like availability, costs, dosimetry, waste management, which will be highlighted in this issue.

Dr. Marc Pretze
Prof. Dr. Jörg Kotzerke
Guest Editors

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