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Nuclear oncology uses radionuclides (radioactive isotopes) in the diagnosis and management of cancer.
Indiana University Health Goshen Center for Cancer Care is one of the few treatment centers in the country to offer a comprehensive nuclear oncology program integrated with surgical and medical oncology clinical practice and research. Clinical applications of nuclear oncology include PET/CT imaging, lymphatic mapping, radioguided surgery and radionuclide therapy with selective internal radiation therapy (SIRT).
In fact, IU Health Goshen Center for Cancer Care is one of the few facilities in the nation, and the only one in the region, to offer patients SIRT treatment for primary and metastatic liver cancer. Through a clinical trial, we were the first in the United States to offer SIRT as a first-line treatment option in patients with metastatic colon cancer to the liver. This study has consistently demonstrated that chemotherapy and SIRT, used in combination, are more effective than chemotherapy alone to fight these types of cancer.
Positron emission tomography
Positron emission tomography (PET) is an imaging technique that detects a tumor’s biologic or functional activity. Tumors with high functional activity or fast growth rate are easily detected by PET. However, they can be missed on a CT scan, MRI or ultrasound. For a PET scan, glucose (a form of sugar) that contains a radioactive atom is injected into the blood. Because cancer cells in the body are growing rapidly, they absorb large amounts of the radioactive sugar. After about an hour, a special camera is used to create a picture of areas of radioactivity in the body.
A CT (computed tomography) scan is an X-ray that produces detailed cross-sectional images of structures in the body. Some machines can perform both a PET and CT scan at the same time (PET/CT scan). These scans fuse anatomic and physiologic information to increase radiation accuracy. The image from a PET/CT scan is a more precise way to detect and identify the exact cancerous location. It shows the anatomy and tumor behavior at one time. PET/CT offers the ability to monitor the effectiveness of a treatment and adjust the plan during, rather than at the end, of treatment.
Lymphatic mapping helps determine the routes of cancer spread via the lymph nodes. Using lymphatic mapping, surgeons determine the first lymph node (called sentinel node) to be afflicted by cancers. The procedure involves the injection of radioactive particles at the site of the primary tumor. The radioparticles are absorbed by the lymph channels and accumulate in the sentinel nodes. The surgeon can identify the sentinel nodes by using a gamma probe that detects radioactive lymph nodes during surgery. The lymphatic mapping technique prevents a more extensive surgery of removing all the lymph nodes to determine the spread of cancer.
Radioactive iodine treatment
Radioactive iodine treatment (RAI) is a form of radionuclide therapy. It is given to all patients diagnosed with thyroid cancer following initial surgery. RAI treatment, also called RAI ablation, eliminates the remaining small amount of thyroid tissue after surgery to facilitate follow-up with patients using thyroglubulin serum marker. Patients who have metastatic disease receive higher doses of RAI for eradication of visible and microscopic cancers in the body. Most centers use a fixed-dose regimen for RAI treatment of recurrent and metastatic cancer.
Selective internal radiation therapy
IU Health Goshen Center for Cancer Care performs an innovative treatment for liver cancer that cannot be treated surgically. Known as selective internal radiation therapy (SIRT), this state-of-the-art, targeted radionuclide therapy uses millions of microscopic radioactive beads, known as microspheres, to help destroy tumors from the inside out. This unique therapy spares healthy tissue while delivering up to 40 times more radiation to the liver tumors than would be possible using conventional therapy.