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The role of radionuclide therapy in medullary thyroid cancer
Maria Rita Castellani1, Alessandra Alessi, Giordano Savelli
1Nuclear Medicine Division, National Cancer Institute, Milan, Italy. r.castellani@istitutotumori.mi.it
Abstract:
In medullary thyroid carcinoma (MTC) the detection of occult metastases is difficult and the prognosis of widespread disease is poor. In recent years several radiopharmaceuticals have become available for the diagnosis of this tumor. None of these tracers, however, has satisfactory diagnostic sensitivity and specificity. Furthermore, only few radiopharmaceutical compounds proved to have clinical value in therapeutic applications. Radionuclide therapy utilizes unsealed radioactive sources in order to deliver selective irradiation to the target organs or cancer lesions. This approach is only clinically indicated when there is a scintigraphic evidence of sufficient tumor uptake and a favorable biodistribution. When these conditions are present, radionuclide therapy can be adopted in MTC patients. Due to the low incidence of this tumor, the poor sensitivity of the available radiopharmaceuticals and their limited indications, the clinical experience in radionuclide therapy of MTC is still limited and there is general agreement among experts that it has only a palliative role. Here we briefly report the main experiences in radionuclide therapy in the past and in recent years. In addition, we summarize the results obtained with 131I-MIBG therapy at the Istituto Nazionale Tumori of Milan, as well as the most important ongoing preclinical and phase I/II trials.
Insights
Diagnosing medullary thyroid carcinoma (MTC) metastases is challenging. Radionuclide therapy offers a palliative role for MTC, but requires specific uptake evidence and has limited clinical experience.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiopharmaceutical Therapy
Background:
- Medullary thyroid carcinoma (MTC) presents diagnostic challenges for occult metastases, with a poor prognosis for widespread disease.
- Current radiopharmaceuticals for MTC diagnosis lack satisfactory sensitivity and specificity.
- Limited radiopharmaceutical compounds demonstrate clinical value in therapeutic applications for MTC.
Purpose of the Study:
- To review past and recent experiences in radionuclide therapy for medullary thyroid carcinoma.
- To summarize outcomes of iodine-131-meta-iodobenzylguanidine (131I-MIBG) therapy at the Istituto Nazionale Tumori of Milan.
- To highlight ongoing preclinical and phase I/II trials in MTC radionuclide therapy.
Main Methods:
- Review of existing literature on radionuclide therapy in MTC.
- Summary of clinical data from 131I-MIBG therapy at a specific institution.
- Overview of current research in preclinical and early-phase clinical trials.
Main Results:
- Radionuclide therapy is indicated in MTC when scintigraphy shows sufficient tumor uptake and favorable biodistribution.
- Clinical experience in MTC radionuclide therapy is limited due to low tumor incidence and radiopharmaceutical limitations.
- Current expert consensus suggests a palliative role for radionuclide therapy in MTC.
Conclusions:
- Radionuclide therapy in MTC is a palliative approach with limited clinical application.
- Further research and development of targeted radiopharmaceuticals are needed.
- Ongoing trials aim to improve the efficacy and broaden the indications for MTC radionuclide therapy.
