Description

Nuclear Oncology (Nuclear Medicine)

Applications of Nuclear Medicine in oncology are increasingly covering diagnostic and treatment applications that have been specialized in different types of cancer. Directed by Prof. Cüneyt Türkmen, our Nuclear Oncology team is well-known in performing novel approaches under challenging conditions at a high success rate.

• Positron Emission Tomography (PET-BT and PET-MR), which is now the standard method for imaging many cancer types, offers the advantages of molecular imaging in the diagnosis and treatment of cancer. These benefits provide significant contributions to increasing the life expectancy of patients, from early diagnosis of cancer to treatment management.

Developments in the field of molecular imaging also led to the spread of individualized radionuclide treatments defined by the concept of “teranostics” for each patient.

What is “teranostic” approach?

Teranostics is a new field of medicine that combines patient-specific and targeted diagnosis and treatment. It is derived from the words “Therapy” and “Diagnostic”. Detection of diseased areas using targeted molecules in the teranostic approach, and then with the help of therapeutic agents, cancerous cells without much damage to other tissues intended to be destroyed. Diagnostic tests show the presence of receptor/molecule on the target tissue, leading to the use of specific therapeutic agents. Afterwards, it is also possible to monitor the response to treatment.

In the teranostic approach with radionuclides (radioisotopes), the detection of the tumor using unique biological pathways, followed by cellular irradiation of the tumor with a therapeutic radionuclide is intended. This approach provides effective treatment for the patient at the right time, at the right dose and targeted.

177-Lutesium/ 90-Yttrium octreotate for neuroendocrine tumors in the field of teranostic Nuclear Oncology, 177-Lutesium PSMA for metastatic or treatment-resistant prostate cancer, metastatic liver cancer For 90-Yttrium SIRT, iodine 131 for thyroid cancer and Radium-223 treatments are widely used for patients with prostate cancer with bone metastases.

Transarterialradioembolization (TARE)

(Y-90) transarterial radioembolization (TARE) with charged microspheres entered the management paradigm of primary or metastatic liver malignancies that have no chance of resection and use each is an important method of treatment, which became widespread the other day. It can be interpreted as an intra-arterial form of brachytherapy, a form of radiotherapy, in which radioactive sources are placed inside or near the tumor.

Who are candidates for TARE?

Deciding whether the patients are suitable for TARE treatment in a multidisciplinary Tumor Board consisting of general surgeon, interventional radiologist, nuclear medicine specialist, medical oncologist and gastroenterologist is required.

Patients with

• The Eastern Cooperative Oncology Group (ECOG) performance scale 2 is localized only in the liver or dominant,

• with no chance of operation,

• the expected life expectancy is over 12 weeks, is considered suitable candidates for TARE treatment.

How do we perform TARE?

• Tumor distribution and volume is calculated by using CT or MRI.

• The first angiography demonstrates vascular structure of liver. Some of arteries may be clogged before the final procedure.

• Test drug is used to determine amount escaped to lungs.

• After 15 days, the second angiography is performed through inguinal vein.

• Microspheres are introduced in tumor vessels and/or vessels that feed the tumor.