Dosimetry in Clinical Radiopharmaceutical Therapy of Cancer: Practicality Versus Perfection in Current Practice

Area of Science:

• Nuclear medicine
• Oncology
• Medical physics

Background:

• Radiopharmaceutical therapies (RPTs) are rapidly advancing for cancer treatment.
• Personalized RPT requires dosimetry to optimize tumor dose and minimize normal organ toxicity.
• Current clinical practice and Food and Drug Administration approvals often do not mandate patient-specific dosimetry.

Purpose of the Study:

• To review dosimetry approaches in RPT.
• To assess the extent of dosimetry use in clinical trials.
• To discuss the challenges and limitations of implementing dosimetry in RPT.

Main Methods:

• Review of current RPT agents and clinical trials.
• Analysis of dosimetry methodologies and their application.
• Comparison of dosimetry-based versus fixed activity dosing strategies.

Main Results:

• Dosimetry is critical for personalized RPT but is highly varied and underutilized.
• Factors such as convenience and resource intensity favor empiric dosing over dosimetry.
• Significant potential exists for improving RPT outcomes through wider dosimetry adoption.

Conclusions:

• Dosimetry is essential for maximizing therapeutic benefit and ensuring safety in RPT.
• Overcoming practical limitations is key to increasing the clinical use of dosimetry.
• Further research and standardization are needed to promote dosimetry-based RPT.