To be successfully treated, a cancer should be detected as early as possible, and should be addressed in multidisciplinary specialist committees, including doctors of various medical specialties, surgeons, oncologists, radiotherapists, anatomopathologists, imaging experts and nuclear medicine. If a cancer is not treated multidisciplinary, the chances of successful treatment decrease. Also, if it is detected in its advanced stages, the extent of the disease then increases the case difficulty. But today, in the world’s elite oncology centers, such as ACIBADEM, the performance of technology and doctors’ expertise make it possible to treat advanced cancer cases as well. To be successfully addressed, physicians need information about the location of tumors, metastases, but also about their metabolic activity. This is achieved by technologies such as PET-CT, SPECT CT, scintigraphy using radiopharmaceuticals. These are labeled substances with radioactive elements that are absorbed into tumors and allow both their detection and targeted treatment. Here are some of these, successfully used in oncology patients by Prof. Dr. Erkan Vardareli, of the ACIBADEM Altunizade Hospital’s nuclear medicine department.18f-FDG. This is radiolabelled glucose with fluorine, one of the most used substances in nuclear medicine. With it, physicians can assess the metabolic activity of several types of malignant tumors. It is injected into the body and is primarily absorbed by malignant tumors, which have an increased metabolism of glucose. Thus, after scanning the entire body through PET-CT, physicians obtain information about tumor activity and establish targeted therapies. PET-CT with FDG injection is also important in follow-up programs, but also in monitoring the effectiveness of oncology therapy during the follow-up.
177-PSMA Lutetium. “At this time, with Lutetium-177, we can treat conditions like prostate carcinoma or neuroendocrine tumors. We can also treat certain metastatic bone lesions, painful bone metastatic lesions and certain lesions in arthritis. But the most common use is in prostate carcinoma, metastatic prostate lesions after surgery and hormonal and chemotherapeutic treatments. Also, with Lutetium-177, we can provide therapies for lymph node metastases in palliative therapies to relieve pain”, describes Prof. Dr. Erkan Vardareli of the ACIBADEM Group of Hospitals the use of Lutetium-177.
Gallium-68 PSMA. This substance is of particular value for the detection of certain recurrent prostate cancers or for prostatic metastases. Gallium-68 PSMA is injected into the body, and through PET-CT scanning, physicians experienced in nuclear medicine can highlight prostate-specific membrane antigen (PSMA), which increases in over 90 percent of prostate cancers.
Gallium-68 DOTA-TATE. “This is a special agent used in assessing neuroendocrine tumors that can occur in the pancreas, at the gastrointestinal level. And some tumors that occur in children such as neuroblastoma, retinoblastoma, neuroglial blastoma have affinity for GA-68 DOTA-TATE, as well as brain tumors of the meningioma type. In addition, certain lung tumors such as small cell lung carcinoma respond to this radiopharmaceutical. Thus, agents such as GA-68 DOTA-TATE or Lutetium DOTA-TATE can be used to diagnose and treat malignancies that I mentioned”, says Prof. Dr. Erkan Vardareli.
Radioactive Iodine. “Nowadays, we treat patients for refractory hyperthyroidism in medication, but also for thyroid carcinomas. After thyroid gland removal, we can apply the radioactive iodine treatments to see if there is residual tissue for ablation of the remaining tissue and for metastases if they exist in the lymph nodes or at a distance. Radioactive iodine protocols are important for follow-up in the malignant pathology of the thyroid, to see if there is any remaining tissue or if metastases are formed”, describes Prof. Vardareli the uses of radioactive iodine.