An EANM position paper on advancing radiobiology for shaping the future of nuclear medicine

Excerpt

Personalized medicine is an important facet of medical radiation research programs and roadmaps of strategic research agendas (EURADOS or EURAMED) [1, 2]. Indeed, patient-specific dosimetry in radiopharmaceutical therapy (RPT) and particularly for treatment planning is progressively implemented in clinical practice (ICRU report 96 and ICRP Publication 140 [3, 4]). However, we often still lack radiobiological understanding to address the clinical unmet needs (EANM radiobiology position paper [5] and [6‐12]). Selection of patients for RPT based on imaging confirmation of the RPT-directed target alone seems to be insufficient as even in the VISION clinical trial more than half of the PSMA-PET positive patients showed a PSA-decrease of less than 50% [13]. In RPT, most treatments are administered systemically and in addition to tumor tissue some part of the body may receive high absorbed doses. However, RPT is generally well tolerated and the current therapy regimens seem to undertreat patients which again strongly underlines the need for a better radiobiological understanding of the required tumor doses, the radiation tolerance of the organs at risk as well as the potential synergistic value of combination therapy. Because radiobiology of EBRT cannot be extrapolated to RPT, there is a need for specific radiobiology of RPT [6]. …