The increasing potential of nuclear medicine imaging for the evaluation and reduction of normal tissue toxicity from radiation treatments

• Published in: European journal of nuclear medicine and molecular imaging Vol. 48; no. 12; pp. 3762 - 3775
• Main Authors: Mohan, V., Bruin, N. M., van de Kamer, J. B., Sonke, J.-J., Vogel, Wouter V.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2021; Springer Nature B.V
• Subjects: Biocompatibility; Brachytherapy; Cardiology; Diagnostic Imaging; Drug dosages; Evaluation; Humans; Imaging; Imaging techniques; In vivo methods and tests; Medical imaging; Medicine; Medicine & Public Health; Miscellanea; Neoplasms - diagnostic imaging; Neoplasms - radiotherapy; Nuclear Medicine; Oncology; Optimization; Orthopedics; Radiation therapy; Radioisotopes; Radiology; Radiotherapy Planning, Computer-Assisted; Review; Review Article; Spatial discrimination; Spatial resolution; Toxicity; Tumors; Molecular imaging; Radionuclide therapy; Radiotherapy; Toxicity
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-021-05284-5

Radiation therapy is an effective treatment modality for a variety of cancers. Despite several advances in delivery techniques, its main drawback remains the deposition of dose in normal tissues which can result in toxicity. Common practices of evaluating toxicity, using questionnaires and grading systems, provide little underlying information beyond subjective scores, and this can limit further optimization of treatment strategies. Nuclear medicine imaging techniques can be utilised to directly measure regional baseline function and function loss from internal/external radiation therapy within normal tissues in an in vivo setting with high spatial resolution. This can be correlated with dose delivered by radiotherapy techniques to establish objective dose-effect relationships, and can also be used in the treatment planning step to spare normal tissues more efficiently. Toxicity in radionuclide therapy typically occurs due to undesired off-target uptake in normal tissues. Molecular imaging using diagnostic analogues of therapeutic radionuclides can be used to test various interventional protective strategies that can potentially reduce this normal tissue uptake without compromising tumour uptake. We provide an overview of the existing literature on these applications of nuclear medicine imaging in diverse normal tissue types utilising various tracers, and discuss its future potential.