EURADOS Report 2024-03 published: "Internal dosimetry of radiopharmaceuticals used for therapy - Towards a roadmap for patient specific dosimetry in radiopharmaceutical therapy"
EURADOS Report 2024-03 is published: "Internal dosimetry of radiopharmaceuticals used for therapy - Towards a roadmap for patient specific dosimetry in radiopharmaceutical therapy"
Ramona W. Bouwman, Céline Bouvier-Capely, David Broggio, Salvatore Di Maria, Silvano Gnesin, Kerstin Hürkamp, Jila Karimi Diba, Weibo Li, Balazs Madas, Siria Medici, Mario Medvedec, Vladimir Spielmann
Abstract: This report aims to provide a comprehensive background to promote and define future research to optimize radiopharmaceutical therapy (RPT). For this purpose, experts on several domains, have reviewed relevant literature until December 2022, paying special attention to the present status, challenges and identified gaps related to internal dosimetry of radiopharmaceuticals used for therapeutic applications. In this review report, we focus on the following four topics:
1. Overview of the therapeutic use of radiopharmaceuticals and the development of novel radiopharmaceuticals.
2. Biokinetic and pharmacokinetic models to describe the biodistribution of the radiopharmaceuticals.
3. Historical background and current knowledge in the field of dosimetry.
4. Current knowledge on dose-effect relationships in RPT.
Based on the collected information, we paved the way for a roadmap focussing on three areas defining the main objectives and important tasks which need to be addressed to move towards evidence-based dosimetry-guided prescription of radiopharmaceuticals for therapeutic use:
The first focus area of the roadmap is to assist the development of a repository to facilitate the collection of patient-specific dosimetry data.
The second focus area concerns the translation of the so far matured knowledge into clinically viable patient-specific dosimetry-guided procedures for RPT in the clinical practice.
The third focus area consist in exploiting available dosimetry and effect data to determine reliable dose effect relationships in terms of normal tissue complication probability (NTCP) and tumour control probability (TCP) models for RPT.
In conclusion, introducing evidence-based dosimetry guided procedures in RPT in the clinic still requires substantial research. Additionally, similar to the development of planning and verification tools for external beam radiotherapy, the development of planning and verification tools for RPT will be an iterative process. In each focus area a continuous and iterative process of improvement based on the evolving level of the available scientific knowledge is necessary to offer the best quality of care to patients receiving RPT.
Implementing patient-specific dosimetry in standard clinical RPT is expected to play a major role in supporting the justification and optimization of such procedures. Further research efforts in this domain will then allow RPT to move towards the domain of personalized medicine.
