Nuclear medicine therapy is a cancer treatment that uses radioactive drugs that bind to cancer cells and destroy them. This therapy is an option for some people with neuroendocrine tumors, prostate cancer, meningiomas, thyroid cancer and lymphoma. It has proved to be successful in easing symptoms, improving quality of life and extending life.
The Mayo Clinic nuclear medicine therapy team uses a thorough multidisciplinary approach. It's the key to success, as it brings together all involved team members early in your treatment so they can make decisions that work best for you.
Mayo Clinic has one of the largest nuclear medicine therapy practices in the United States, with services offered at each of its main campuses in Phoenix/Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota.
Team approach to personalized care
Mayo Clinic's nuclear medicine therapy practice brings together a multidisciplinary team of experts who collaborate to develop a treatment plan tailored to you. Depending on your situation, needs and goals, your care team may include specialists in nuclear medicine, endocrinology, gastroenterology and hepatology, hematology, medical oncology, nephrology, neurology, radiation oncology, radiology, and urology.
Nuclear medicine therapy is an approach to treating cancer that might be used with or after other treatment options, such as chemotherapy and surgery. It won't usually lead to a cure unless combined with other therapies. But for many people it will control symptoms and shrink and stabilize the tumors, sometimes for years. Nuclear medicine therapy is sometimes the best option for people who no longer respond to other treatments.
What makes nuclear medicine therapy effective is the use of radioactive molecules as a drug (molecular radiotherapy). The drug recognizes tumor cells. It's injected intravenously, then circulates in the body, sticks to the tumor cells, delivers radiation directly and causes them to die. Some of the drug never attaches to cancer cells and keeps floating in the blood until the body gets rid of it, mostly in the urine. Over time, the radioactive drug stops giving off radioactivity and stops killing cancer cells. Nuclear medicine therapy is often repeated multiple times to achieve the most benefit.
Nuclear medicine therapy is also called peptide receptor radionuclide therapy (PRRT), targeted radiotherapy, radionuclide therapy and therapeutic nuclear medicine.
People with neuroendocrine tumors (NETs), including rare pancreatic NETs, now have wider access to PRRT following the January 2018 U.S. Food and Drug Administration (FDA) approval of lutetium Lu 177 dotatate (Lutathera). This is an important option, as NETs can be widespread throughout the body and hard to remove with surgery.
What you can expect
Once you have a diagnosis and you and your care team have decided that nuclear medicine therapy is the best option for you, you'll be scheduled for treatment. It may take up to a month before you can start therapy while blood and imaging tests are completed, your medications are modified, and therapy is prepared. Usually therapy involves up to four infusion sessions, each usually eight weeks apart.
The treatments are given in an outpatient setting. Plan to be on-site for up to eight hours each time. When you arrive, you'll be cared for by a skilled team of specialists who provide safe and efficient therapy. Treatment usually involves:
- Blood tests so that your care team can monitor cell function and, if needed, take steps to prevent bleeding and infection
- Medications to help prevent nausea and vomiting
- An intravenous infusion of the radioactive drug, which takes up to four hours
- Special medication to protect the kidneys from injury
Tailoring nuclear medicine therapy to you
No two people experience cancer or respond to treatment in the same way. For most people, symptom improvement comes after the second dose. Your care team considers many factors when prescribing your nuclear medicine therapy and adjusts it over time.
After each infusion session, you may be asked to undergo a SPECT scan. This scan measures how much nuclear medicine therapy stuck to the cancer cells and how fast the drug is leaving your body. This information guides your care team members as they choose when and how much therapy to give you to kill the cancer and avoid side effects.
After you have completed your therapy, your doctor will ask that you return regularly for follow-up visits, which may include more blood tests and scans.
Possible side effects
Side effects can occur and they depend on your specific therapy and medical condition. It used to be common for people to experience nausea when receiving nuclear medicine therapy, but that has become far less of an issue. Many people even enjoy eating during therapy. Some people notice hair loss, but it's usually only a little and the hair grows back.
Rarely, someone who has had nuclear medicine therapy might develop a cancer of the blood months or even years later.
Talk with your doctor about the advantages and risks of this treatment.
Deciding whether nuclear medicine therapy is right for you
Your nuclear medicine care team considers many factors before prescribing this type of therapy for you. You'll likely undergo a positron emission tomography (PET) scan to help determine whether nuclear medicine therapy is right for you and your cancer.
When a PET scan is needed, a version of the drug that will later be used for nuclear medicine therapy is injected into a vein. The drug floats around in the blood. If the drug bumps into cancer cells, it sticks. However, this version of the drug does not kill cells. Instead, it gives off only a very small amount of radioactivity.
The radioactivity is detected by the PET scanner, which turns this information into a 3D image of the entire body that can show where cancer is hiding. The PET scan can show if the drug sticks to the cancer as expected. In this way doctors use a PET scan to test if someone might be a good candidate for nuclear medicine therapy.
Other treatment options
Mayo Clinic doctors will work with you to review all of your treatment options and choose the treatment that suits your needs and goals. Nuclear medicine therapy is usually given by itself, but it can be combined with other therapies delivered by medical oncologists, radiation oncologists or interventional radiologists:
Nuclear medicine therapy is available at three Mayo Clinic locations
Most people are referred to the team of specialists in nuclear medicine therapy by one of their doctors. Talk with your doctor about whether your condition makes this treatment a good choice for you. Eligibility for this therapy depends on many factors related to the tumor and your overall health.
You may be seen at any one of the clinic's main campuses in Phoenix/Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. Each campus has the expertise and technology required to guide you through nuclear medicine therapy. Each location has cyclotrons, PET radiochemistry laboratories and nuclear radiopharmacies, all of which are needed to properly handle nuclear medicine therapy and produce the drugs for PET and SPECT imaging. Each campus also has state-of-the-art scanners, including PET/CT, PET/MRI and SPECT/CT.
Cyclotrons are particle accelerators that create radioactive atoms (radionuclides). These atoms then are linked to drugs and checked for quality and safety per FDA regulations. These drugs are made fresh specifically for the people coming to the clinic that day.
Nuclear medicine therapies, some still in clinical trials, are used to treat these conditions:
The Mayo Clinic nuclear medicine therapy team is among the most experienced in creating radioactive drugs and using and administering them safely. Nuclear medicine experts are experienced in:
- Preparing you for radioactive tracers
- Computer processing and image enhancement
- Radioactive chemical compound preparation and administration
- Radioactive therapy
- Radiation safety
Mayo Clinic doctors also have extensive experience treating people with carcinoid tumors, neuroendocrine tumors, prostate cancer and every other condition for which nuclear medicine therapy might be a treatment option. For example, each year they care for more than 1,900 people with neuroendocrine tumors, including rare types. People with uncommon or complex conditions who are seen at medical institutions that treat many people with such conditions seem to have better outcomes than those seen at institutions that treat these conditions less frequently.
Nationally recognized expertise
Mayo Clinic Cancer Center meets strict standards for a National Cancer Institute comprehensive cancer center, which recognizes scientific excellence and a multidisciplinary approach to cancer prevention, diagnosis and treatment.
Mayo Clinic en Rochester, Minn., Mayo Clinic en Phoenix/Scottsdale, Ariz., y Mayo Clinic en Jacksonville, Fla., están clasificadas entre los mejores hospitales oncológicos por U.S. News & World Report.
Research and innovation focused on improving lives
Mayo Clinic is a leader in developing new uses for nuclear medicine to improve the diagnosis and treatment of adults and children with serious or complex conditions.
Mayo Clinic was one of the first medical institutions in the United States to offer a new treatment for people with certain neuroendocrine tumors affecting the digestive tract. The treatment, lutetium Lu 177 dotatate (Lutathera), was approved in January 2018 by the FDA for adults with advanced neuroendocrine tumors that affect the pancreas or gastrointestinal tract, known as gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
The Mayo Clinic Division of Nuclear Medicine is one of a very few programs at select medical centers with experts trained and certified to provide Lutathera. Mayo Clinic was one of the centers to treat people in the landmark clinical trial that led to FDA approval of this therapy.
See a list of publications by Mayo Clinic physicians on PubMed, a service of the National Library of Medicine.
An opportunity to be part of research
If you are eligible to undergo nuclear medicine therapy at Mayo Clinic, your doctor might invite you to be part of one of multiple clinical trials. Programs such as the Early Cancer Therapeutics Group offer options if your cancer hasn't responded to standard treatments.