Recent developments in Nuclear Medicine provide additional treatment alternatives, especially for patients who do not have the chance to undergo surgery. These treatments, which prolong the life span of cancer patients and improve their quality, have the feature of targeted smart therapy that locates the cancerous tissue.
Contemporary treatment approaches in cancer are mostly evaluated under the name of targeted therapies. The target here is cancer cells. Abnormally proliferating cancer cells have different characteristics from normal cells due to various proteins on the surface of the cells or some molecules in them. In recent years, smart treatments have been developed thanks to molecules that can detect the characteristics or weaknesses of cancer cells. When these molecules are given to the body through the mouth or vein, they are directed to the cancerous area.
If you have a special molecule directed to the cancer cell, drugs, atoms or other destructive substances can be loaded into this molecule, depending on the treatment to be applied. These special carriers attached to the molecules can destroy the diseased tissue at the cellular level by selectively delivering the therapeutic substances to the target where the cancerous cells are located in the body. Thus, both healthy tissues are less affected and more effective doses can be used.
Molecular therapy provides a new weapon in the fight against cancer. It gives an additional chance to patients who have exhausted all treatment options or in cases where surgical methods cannot be used. These new methods can be applied as a final blow to bad cells in people with more advanced diseases. However, as experience increases, such treatments can be applied at earlier stages of the disease.
New molecular diagnostics and treatments have started to be used in the diagnosis and treatment of prostate cancer and will be used more widely shortly. In blood tests, there is a tumor marker called PSA among people. After the diagnosis of prostate cancer, the stage of cancer can be determined by imaging. It acts with the same logic as molecular targeted therapies. PET/CT imaging method was developed by using PSMA protein specific for prostate cancer. PSMA PET/CT has the potential to detect metastases in prostate cancer that has the potential to spread and to prevent unnecessary interventions and treatments. In patients who are found to be metastatic and resistant to standard treatments, targeted therapy can be performed with lutetium PSMA using lutetium 177, a high-energy atom. Another molecular therapy that has recently been applied in prostate cancer is radium 223. Bone metastases of hormone-resistant prostate cancers can be targeted with radium 223. Radium 223 treatment has been shown to prolong survival in prostate cancers with extensive bone metastases.
Radioactive iodine therapy, which is the most widely used radionuclide therapy and applied in known thyroid cancer, is also known as atom therapy among people. It is a treatment method with proven success and reliability that has been applied for many years. It is a treatment that should be applied to the majority of patients diagnosed with thyroid cancer after surgery. Radioactive iodine accumulates in the remaining cells after the entire thyroid gland is surgically removed. With the rays it emits, it also ensures the removal of microscopic residues. It is a method that is applied in relapsed patients by giving repeated high doses if necessary. The treatment is very simple, it is administered orally by drinking radioactive iodine in the form of capsules or liquids.
Radionuclide therapy may be an option in cases of lymph node cancer called lymphoma that does not respond to other treatments. It can be applied to selected cases among patients diagnosed with low-grade lymphoma. Antibodies called CD20 due to radioactive substances such as Yttrium-90 or Iodine-131 are directed to antibody targets in cancerous cells and destroy the cells by emitting high-level rays at the microscopic level. The response can be obtained in more than half of the cases in this type of disease, which is resistant to other treatment methods.
Nuclear medicine is not used in the treatment of all types of cancer. Nuclear medicine, which is a rapidly developing treatment method, can be used in neuroendocrine tumors, some types of lymph cancer, liver, toxic goiter and thyroid cancer, some tumors seen in childhood, and prostate cancer by choosing the right patient. However, the patient should be evaluated by a multidisciplinary team consisting of multiple experts from the diagnosis stage and a treatment plan should be made. Considering the progress, it is correct to describe the point reached as the visible part of the iceberg.