By Sébastien Vauclin
Molecular radiotherapy (MRT) is a promising and quickly expanding set of therapeutic options for treating many cancer cases, including cases where conventional techniques are unsuccessful. Cancer cases have been treated with radiopharmaceuticals since the 1940s, but the number and range of radiotherapeutics on the market have recently expanded significantly.
To help optimizing radionuclides-based therapies in clinical routine, software and digital technologies are expected to play an innovative and primary role in the future. In parallel with their tremendous contribution over the past 20 years to the external beam radiation therapy (EBRT) domain, software technologies bear the same promise for MRT: image-based, 3D voxel-level precision, patient-specific adaptive treatment planning, in vivo dose control, etc. These well-known features and corresponding benefits in EBRT are fairly new to the MRT world and will become de facto standards of practice within the next few years.
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The even more recent software technologies, also called digital technologies, have an even bigger potential impact and benefit for the prognosis, improvement and personalization of cancer therapies. Indeed, the next challenge is to go from protocol-based treatments “one size fits all”, to fully personalized diagnosis, prognosis, treatment planning and patient follow-up. A given patient being nowadays characterized by more than 10,000 descriptors, only software and data-driven machine processing can fully take into account such complexity.
Cancer diagnostics, treatment planning and patient follow-up in molecular radiotherapy
Nuclear medicine has the intrinsic potential of allowing pre- and post-therapeutic in vivo bio distribution studies. Molecular radiotherapy, which involves the metabolic vectorization of radioactive products within tumors and their selective destruction, is an alternative suggested in an increasing number of cancer treatment centers worldwide.
However, the increment of radionuclide therapy applications has brought the attention of both the scientific community and the institutional bodies to the need for personalized planning and verification of the absorbed dose delivered to individual patients, as is currently standard practice in external beam radiotherapy (EBRT).
It represents a challenge, especially, for radionuclide treatments given systemically, whose bio distribution and ultimate targeting is greatly heterogeneous among individuals and whose therapeutic effect is exerted over a long period of time (days or weeks in many cases, depending on both biological and physical properties of the radiopharmaceuticals).