Nuclear medicine cancer treatment. Nuclear medicine against cancer

01.07.2020

During the year, five nuclear medicine centers were opened in Russia, where cancer is diagnosed by combined positron emission and computed tomography (PET / CT). The Ministry of Health believes that the work of a federal network of such centers will reduce cancer deaths by a quarter. Oncologist, Doctor of Medical Sciences, Professor Alexey Butenko tells about the specifics of PET / CT and who needs such diagnostics..

- Alexey Vladimirovich, we see that high hopes are pinned on the introduction of PET / CT technology. And what is the benefit of conducting this examination for a particular patient?

- Yes, increasing accessibility is a very important task. Individualization of treatment is becoming one of the main goals of oncology. After all, no two tumors are alike, they differ in size, location, structure and many more parameters. Thanks to PET / CT, we receive information about these features of the tumor in each patient and, based on them, we can choose the tactics of treatment. The uniqueness of the method is that it allows you to assess not only structural, but also functional changes in organs and tissues. A characteristic feature of cancer cells is an increased metabolism, thanks to this feature, malignant tumors are visible on PET / CT. The method is able to identify those tumor foci that cannot be detected using other imaging tools - ultrasound, X-ray, CT, MRI. PET / CT is also used to monitor the effectiveness of treatment.

- And such detection of metastases allows for better planning of the operation?

- Not only. If we are talking about the prevalence of a tumor, establishing the true stage of cancer, then PET / CT is used here as a method of clarifying diagnosis. The use of this tool after using standard methods - ultrasound, CT, MRI - allows in about 60% of cases to change the stage of the disease: in 35% - towards its increase, and 25% - towards its decrease. That is, about half of patients receive more individualized and accurate treatment thanks to the results of PET / CT. They will not undergo retreatment, they will not undergo ineffective surgical interventions.

Lymphoproliferative disease, PET / CT diagnostic findings. On the left - before treatment, on the right - after treatment.

As I said, there is another aspect of using the method - dynamic monitoring of treatment results. You can judge its effectiveness at the anatomical level - for example, notice that the lesions in the lung have become smaller. It is also important to know the functional state of the tumor. Indeed, in the process of treatment, the focus can be anatomically preserved, but there are no cancer cells there - they died from the action of drug or radiation therapy. PET / CT is just what allows you to assess the functional effectiveness of treatment. If, after 2-3 courses of treatment, we see that the activity of the tumor has decreased - this indicates that the treatment was chosen correctly and must be continued. And vice versa, if there are no changes in the functional activity of the tumor, we can confidently assert that our treatment will not allow achieving the desired results and it is necessary to change tactics as soon as possible. Being able to monitor whether our drug portfolio is working also means reducing the toxicity of chemotherapy.

- For what types of tumors is such a diagnosis necessary in the first place?

- Over the years of the use of PET / CT, the number of oncological diseases in which it is recommended has increased significantly. Nowadays there are practically no such localizations for which PET / CT is ineffective. The whole point is to select a drug that would accumulate in the tumor and make it visible. In world practice, the vast majority of PET studies are carried out with fluorine-labeled glucose.

And if you list the diseases for which the method works well - first of all, you need to name lung cancer, lymphoma, head and neck tumors, cancer of the brain, esophagus, stomach, pancreatic cancer, ovarian cancer, cervical cancer, breast, prostate cancer, melanoma, gastrointestinal, neuroendocrine tumors. Already offhand - a dozen nosologies.

Administration of a radiopharmaceutical to a patient

- Is there any data on how many Russian cancer patients today need PET / CT?

“Taking into account the cancer incidence in 2014, we calculated that it is necessary to conduct about 750 thousand studies in the Russian Federation. In doing so, we proceeded from the current clinical guidelines. Taking into account all those who can benefit from PET / CT, the numbers would be even higher.

— And how affordable is PET / CT for Russians?

- To get closer to the European indicators of availability, we need to increase the number of PET / CT scanners by an order of magnitude - to about 150. And to the US standards two to three times further. After all, PET / CT has been used in world practice for 10-15 years. By standards, it is performed primarily before surgery, and in almost all countries this method is paid for by insurance companies.

Many of our doctors are professionally well aware of the options for using the method according to literature data. But they do not have the practical ability to widely use it in their work. Before the creation of the federal network of nuclear medicine centers, PET / CT scanners operated only in Moscow, St. Petersburg and several other large cities, which can be counted on the fingers of one hand.

In addition, say, in Moscow, PET / CT is done on the basis of state institutions, but they work within the framework of self-supporting services, that is, the patient must pay for the study.

- Is it possible to undergo diagnostics for free in the system of the federal network of centers?

- Yes, for example, patients from Bashkiria can undergo a PET / CT scan in Ufa at the expense of compulsory medical insurance (MHI) on a doctor's referral. According to our legislation, all citizens, regardless of their place of registration, have equal access to medical care. But so far the mechanisms of mutual settlement between the territorial divisions of the CHI funds have not been regulated. When this is done, patients from the Tula region will be able to undergo free diagnostics in the direction of a doctor, for example, in one of the nearest nuclear medicine centers - in Orel or Lipetsk. It is not necessary to create a center in each region - one scanner can perform about 20 examinations per day, which is about 5 thousand procedures per year. For some regions this is too much, for some it is, on the contrary, not enough, which means that somewhere you need to run two or three PET / CT scanners, and somewhere - send patients to a neighboring area. It is not difficult to calculate the need for such diagnostics, but using all the capabilities of the federal network will only allow mechanisms for mutual settlement and improved patient routing.

- Do you think our doctors are ready to use the full potential of the method?

- Many experts were really of the opinion that PET / CT is not the most necessary innovation. But this was due to the fact that the method itself was not available, and even very literate, "advanced" doctors knew about it only from literary sources. But as soon as the method begins to be implemented in a specific region, the opinion about it begins to change - the advantages of a more accurate diagnosis, effective dynamic observation during treatment become obvious.

- Let's imagine that in front of you is a patient, a fairly wealthy person. He asks where it is better for him to undergo PET / CT: in Russia, or, say, in Israel?

- The choice is in any case for the patient himself. But it is important to know that the quality of PET / CT diagnostics depends on two things: technical equipment and training of specialists. As far as I know, nuclear medicine centers are adequately equipped with equipment from reputable manufacturers. As for specialists, you need to remember that people work everywhere, not robots. If a doctor has trained in good clinics, he is attentive to each patient - the reliability of the results will be equally high in Russian and foreign centers.

StrAU "Nuclear Technologies for Oncology" covers TPU developments in the field of nuclear technologies for diagnostics and therapy of oncological diseases. StrAU solves the problem of internationalization of educational programs in this area and strives to achieve new results in the areas of generation of high-intensity streams of ionizing radiation and nuclear medicine. The results of the StrAU contribute to solving a serious global problem - increasing the duration and quality of human life.

Key educational programs

"Nuclear Physics and Technology"
"Physics"
"Electronics and Automation of Physical Installations"
"Chemical technology of materials of modern energy"

The main directions of research or significant engineering projects

Creation of a radiopharmaceutical preparation based on 99mTc-labeled doxorubicin for cancer imaging and prediction of the effectiveness of chemotherapy.
Development of a software and hardware complex for the analysis of biological objects based on small-sized betatrons and generators of quasi-monochromatic X-ray radiation.
Development of non-disturbing methods for diagnostics of parameters of beams of charged particles of accelerator complexes based on polarization radiation.

Main expected results from the implementation of the StrAU

Training of world-class specialists in the field of nuclear medicine.
Tandem targeted RFP based on 99mTc / 186Re isotopes for early diagnosis and personalized therapy using monoclonal antibodies.
Hardware complex based on small-sized betatrons for intraoperative therapy of malignant neoplasms and methods of its planning taking into account glucose metabolism in tumor tissue.
Equipment and methods for neutron capture and photon capture therapy of rare types of brain cancer (glioblastoma) using effective radiosensitizers based on gadolinium.

Partners: Rosatom State Corporation, Roskosmos State Corporation, Rostec State Corporation, Rosenergoatom Concern, TVEL OJSC, Paris-Saclay University (France), Technical University of Munich (Germany), European Organization for Nuclear Research (Switzerland) , Siberian State Medical University, National Institute of Nuclear Physics (Italy), etc.

Using beams of high-energy protons, neutrons, or β-active ions to treat cancer.

Types and methods of nuclear therapy in oncology

Currently, there are several types of nuclear therapy.

Proton therapy for cancer.
Neutron isotope therapy.
Heavy ion therapy.
SIRS therapy.

The main methods of nuclear therapy used in clinics abroad are proton therapy, heavy ion therapy, and SIRS therapy.

Proton therapy

This type of cancer treatment has appeared relatively recently, but the number of proton therapy centers abroad is already in the tens. In Europe alone, today there are about 10 proton therapy clinics. Most of these centers have equipment manufactured by the Belgian company IBA Proton Therapy.

Proton therapy - what is it ?

The proton beam is accelerated using a cyclotron or synchrotron. The final energy of the beam of emerging particles determines the depth of penetration and, therefore, the location of the maximum impact energy. Since the beam is easily deflected in the transverse direction by means of electromagnets, the raster scanning method can be used, that is, the beam is quickly moved over the target area. And due to the fact that the energy of the beam and, therefore, the depth of penetration changes, the entire volume of the target can be covered in three dimensions, providing radiation that exactly matches the shape of the tumor. This is one of the main advantages of this method over conventional radiation therapy.

What is the essence of the proton therapy method

Unlike X-rays or gamma rays, the maximum dose of proton radiation is generated at a strictly defined distance from the radiation source. And after this maximum, the radiation completely dries up.

Due to this, it is possible to achieve the maximum effect precisely in the tumor zone, without affecting in any way the healthy tissues behind it along the course of the radiation action.

Benefits of proton therapy

Minimal impact on healthy tissue.
Reducing the likelihood that radiation will cause new cancer (secondary tumor).
The most powerful effect on the tumor.
Wider range of indications for use.

Indications for the use of proton therapy

The effectiveness of proton therapy in glioblastoma, rectal and prostate cancer has been confirmed.

Proton therapy is especially indicated for the treatment of:

cancer in children;
a number of rare cancers in adults for which there is no or, such as tumors at the base of the skull, near the spine, or near the optic nerve.

Side effects and consequences of proton therapy

Despite the fact that proton therapy is the safest method of therapy, it does not do without certain side effects.

All the consequences of the method can be divided into two types.

Effects associated with the effect of protons on healthy tissues located in front of the tumor along the proton beam - skin inflammation, hair loss, itching, numbness and rashes at the site of the beam exposure.
The effects caused by the destruction of the tumor are general intoxication, fever, increased fatigue, allergic reactions.

Proton therapy cost

The cost of a proton therapy session is in the thousands (and sometimes tens of thousands) euros. However, this is often quite justified, given its effectiveness, and sometimes no alternative. The nuance is that the price in different centers where proton therapy can be done can differ greatly, and you need to be very careful about choosing a particular clinic.

Heavy ion therapy

Carbon ion therapy uses particles that are more massive than protons or neutrons. Carbon ion radiotherapy is gaining increasing attention from scientists as technological capabilities improve, and clinical studies demonstrate its benefits in treating many types of cancer, such as glioblastoma, locally recurrent rectal cancer.

The method also has clear advantages for treating otherwise difficult to treat hypoxic and radioactive cancers.

By mid-2017, more than 15,000 patients were treated worldwide in 8 operating centers. There are currently five heavy ion radiation therapy units in operation (of which 2 are in Europe), and there are plans to build more units in the near future.

Biological benefits of heavy ion therapy

All methods of treatment with heavy particles (protons, ion beams) demonstrate a certain maximum effect at a certain point in the body. Therefore, they provide the maximum lethal dose in or near the tumor. This minimizes harmful radiation from the surrounding normal tissues.

Carbon ions are heavier than protons and thus provide a higher relative biological effectiveness (RBE). Their effect on tumor cells is both stronger and more precise, which makes it possible to destroy the maximum number of atypical cells.

SIRS-therapy (SIR-spheres)

The SIR sphere Y-90 is a polymeric artificial medical micro-device used in selective internal radiation therapy for the treatment of inoperable liver tumors.

The use of external radiation for the treatment of liver tumors is limited by the high sensitivity of healthy liver tissue to radiation. Selective internal radiation therapy using SIR-Spheres allows access to radiation therapy for inoperable primary and secondary liver tumors, while protecting healthy cells.

Polymer microspheres SR-spheres are disposable nanoimplants. They contain the isotope yttrium-90 and have an average diameter of 32.5 microns.

Yttrium-90 is a high-energy beta-emitting isotope with no primary gamma emission. The maximum energy of beta particles is 2.27 MeV with an average value of 0.93 MeV. The maximum emission range in fabric is 11 mm with an average of 2.5 mm. The half-life is 64.1 hours.

These properties of the SIR-Spheres polymer microspheres cause the microspheres to settle primarily in the microvasculature surrounding the tumor, maximizing the antitumor therapeutic effects and minimizing the effect on healthy liver cells.

Nuclear Therapy Using SIR-Spheres:

lengthens the recurrence intervals;
increases overall survival;
potentially reduces the size of the tumor before surgery;
alleviates the symptoms of the disease.

SR-spheres can be combined with modern ones or administered as monotherapy. Also, this method can be used as an alternative to local chemotherapy.

Learn more about the possibilities of nuclear therapy. Write to us or order a call back, we will provide you with all the information you need.

Nuclear medicine is one of the most innovative areas of medicine, where radioactive isotopes are used for treatment and diagnostics. With the help of the latter, doctors are able to diagnose oncological diseases at a stage when they are not yet registered by a conventional tomograph.

Early diagnosis of cancer significantly increases the patient's chances of recovery. After all, even when doctors know that a patient has cancer, in order to prescribe the correct treatment, it is important to determine the primary focus of the tumor.

The uniqueness of the combined positron emission and computed tomography (PET / CT) technology is also in the fact that it allows not only to see how certain parts of organs and tissues look, but also to see how the metabolism proceeds in the cells of the body. Cancer cells grow and multiply more actively than others, therefore they consume the most glucose. Before the study, glucose labeled with radioisotopes is injected into the patient's body, and it is this glucose that is visible on the images obtained with the PET scanner. Therefore, areas of the body inhabited by diseased cells are clearly distinguishable on PET / CT images.

Back in 1998, the American analytical company Frost & Sullivan released a study predicting a sharp increase in the use of drugs and diagnostic methods of nuclear medicine. The forecast turned out to be true, but only for European countries, the USA and Japan, where doctors actively use radioactive isotopes for the treatment and diagnosis of patients. In the United States alone, there are over 300 PET centers that use radiation to make a diagnosis. In Russia, their number is much lower.

"I wanted to cry, stop leaving the house"

Specialists from one of the Russian centers helped a teacher from Neftekamsk (Bashkiria) Maria Alexandrovna K... find the right treatment. Despite the terrible diagnosis - the woman was diagnosed with cancer under the collarbone - and the course of chemotherapy, she is glad that the doctors managed to find the disease.

“Six months ago, my upper abdomen was very painful,” the woman recalls. - However, the work still did not allow me to go to a specialist: the academic year had just begun, and, in principle, I am not a fan of visiting doctors. So she was treated herself from time to time. "

Over time, the woman began to feel worse. However, I signed up for a consultation with a specialist only after I felt the seal under the collarbone with my hand.

“After reading the forums, I decided that it was something with my chest. Then I rushed to the surgeon. He examined me, sent me for an X-ray and a doctor. The therapist, when he found out that I still had pain in the upper abdomen for several months, recommended a gastroscopy, ”said Maria Alexandrovna.

Analyzes showed nothing. The doctors had not been able to make a diagnosis for another month.

“I wanted to cry, to stop leaving the house. But finally, the oncologist sent me to Ufa, to the nuclear medicine center, to undergo PET scan - she checks the body for cancer. Then it was determined that I had tumor metastases under my collarbone, ”a teacher from Bashkiria said, adding that she had already begun to undergo treatment.

Diagnostics saves lives

According to oncologists, situations when it is impossible to make a diagnosis are some of the most difficult in practice. Each type of tumor has its own sensitivity to treatment, with many of them, medicine has learned to cope better in the last 10-15 years. But the whole arsenal of tools is useless if you don't know what to fight with. Another difficulty is to determine how far the tumor has spread, which organs it has already affected - the choice of the most effective method of treatment depends on this. Cancer diagnostics using PET / CT helps doctors to see the "portrait" of cancer, to reveal even the smallest foci of the disease: the technology allows to distinguish tumors with sizes of 4 mm or more. The PET / CT procedure itself is painless. The patient learns the results of the diagnosis on the same day the study was done.

About half a million of our citizens fall ill with cancer every year in Russia. And the chances of winning are great only for those who are lucky enough to "catch" the tumor in the early stages. Unfortunately, we manage to determine oncology too late, when the body is affected by metastases. A new method of isotope diagnostics and nuclear treatment, which have been saving Europeans from oncology for several decades, are gaining momentum in Russia. "World of news", 26.07.2012

FIND AND DESTROY

Physicians and nuclear physicists have joined forces in the fight against oncology. Now the tumor will be determined by highlighting pathogenic cells with the help of special equipment, and then they will be shot with a proton cannon.

The first stage is diagnostics. No X-rays, ultrasounds or individual organ checks. A huge apparatus, similar to the Andron Collider, scans the entire body and catches cancer at the stage of several cells, while the patient and the doctor may not even suspect where the problem is rooted.

The numbers speak for themselves: in Europe, where the method is widely used, 80% of patients are diagnosed at the first and second stages, in Russia, in 75% of cases - at the third and fourth stages. “Imagine a situation when traditional studies do not reveal anatomical changes in the brain, but there is a disease and does not allow the patient to live in peace. Nuclear medicine makes it possible to diagnose at the earliest stage and begin effective treatment, ”says Georgy Manikhas, chief physician of the St. Petersburg State Clinical Oncological Dispensary. - We examine the patient's body literally from head to toe without radiation exposure. Traditional diagnostic methods, such as tomography or X-ray, are used to examine only specific areas in the patient's body because the radiation exposure is too high. And complexes of isotope diagnostics are safe for health. "

According to Alexander Elinson, Director General of NIPK Electron for the production of devices for isotope diagnostics, the diagnostics itself is more like a relaxation session. All that is required of the patient is to relax. He is injected intravenously with special substances - radiopharmaceuticals (RFP), which are distributed throughout the body in about half an hour. And then the patient is shone through on the installation. As a result, a map of the whole organism with problem areas appears in front of the doctor. For example, if a doctor sees that radioisotopes are avoiding a certain area, it means that blood flow here is reduced due to the formation of blood clots or atherosclerotic plaques. If, on the contrary, isotopes are intensely concentrated in one place, this indicates the presence of a malignant formation.

According to the doctors, nuclear diagnostics can diagnose the whole spectrum of cancer, cardiac diseases, diseases of the thyroid gland, lungs, kidneys, gastrointestinal tract, veins of the extremities and inflammatory diseases of the skeleton (bones). So, bone metastases, calcium leaching are diagnosed at a level of 5-15%, and on x-rays - starting from 30%. In cardiology, the method not only identifies the problem and gives a prognosis, but also estimates the need for surgical intervention with a probability of 86%. “As far as oncology is concerned, the spread of radionuclide diagnostics in Russian hospitals will help to double the survival rate of patients with oncological diseases. According to forecasts of the Ministry of Health and Social Development of the Russian Federation, nuclear medicine is able to increase the early detection of malignant tumors from the current 40 to 75% and reduce mortality from cancer and cardiovascular diseases by 25-30%, ”Georgy Manikhas emphasizes.

PROTON IMPACT ON TUMOR

Well, after the tumor is found, heavy artillery - the proton cannon - enters the battle. According to oncologists, radionuclide and proton therapy destroys diseased cells by acting only on damaged areas in the body without affecting healthy organs. This is a huge breakthrough in the treatment of cancer, as traditional methods such as chemotherapy have side effects on the entire body, making the treatment painful and undermining the patient's strength. And the special sights of the proton-beam system are adjusted individually for each patient.

In addition, the proton gun removes those tumors that the surgeon's scalpel sometimes cannot reach. And there are 10 to 30% of such neoplasms with a complex arrangement. Having drawn in detail in 3D during diagnosis of the affected organ, doctors outline a target for radiation exposure. Data in digital format are fed into the system, and the installation determines the optimal irradiation parameters with the maximum damaging effect on the tumor and the minimum irradiation of healthy organs and tissues. The principle is the same as in radiation therapy, but here a shock dose of radiation is sent to the affected area - ionizing radiation, which literally explodes the entire tumor. Due to this, the treatment becomes more effective, and the tissues surrounding the tumor are much less affected.

Another big plus is that patients now do not need to go to the hospital for a long time, it is enough to just come to the sessions. And the treatment itself takes much less time. Experts believe that the proton gun gives odds to all other methods in jewelry medical practice, for example, in pediatric oncology, tumors of the central nervous system, in complex anatomical areas, tumors localized in the facial region - eyes, sinuses, soft tissues of the face. Previously, oncology in these areas meant the removal of damaged organs and tissues, now patients can save not only life, but also a normal appearance.

Unfortunately, nuclear medicine is available to few: expensive equipment, rare specialists, many patients. According to statistics, annually, per 1000 patients in the USA, diagnostic radionuclide studies are carried out on average 40 patients, in Japan - 25 patients, in Austria - 19, in Russia - only 7. At the same time, about 190 radionuclide methods are used in world medical practice today. , in Russia - only 22. “The queue for nuclear diagnostics is currently at least six months,” complains Georgy Manikhas.